Tumor grade and size are associated with recurrence-free survival in duodenal neuroendocrine tumors. When feasible, a less aggressive surgical approach to treat low-grade and low-stage duodenal NETs should be considered.
Background: Current therapy for Type 1 diabetes (T1D) is characterized by significant glucose variability (GV). Pancreas transplantation (PT) is performed in certain T1D patients with and without end-stage renal disease. To date, GV has been examined to a limited extent after PT.
Methods:We investigated GV using continuous glucose monitoring (CGM) 3-6 weeks after PT.
Results: Eleven patients had simultaneous kidney pancreas transplantation (SPK),nine pancreas after kidney (PAK), and six pancreas transplantation alone (PTA). Mean CGM showed no difference between SPK, 126.5 ± 13.9, PAK 119.9 ± 12.8, and PTA 131.1 ± 29 mg/dL (P value .6). Percentage of time in range (TIR, 70-180 mg/dL) was 92% for SPK, 93.4% in PAK, and 88.5% in PTA with only 0.3%, 1.5%, and 0.3% of time <70 mg/dL. Percentage >180 mg/dL was 7.9% for SPK, 4.9% PAK, and 11% in PTA. Other measures of GV were similar in the three cohorts. In six patients, CGM was performed before and after PT and improved significantly. GV was also better compared with a matched cohort of T1D patients.
Conclusions: All 3 types of PT resulted in excellent glucose control 3-6 weeks postprocedure. CGM outcomes represent an important objective outcome after PT. K E Y W O R D S continuous glucose monitor, glycemic variability, hyperglycemia and hypoglycemia, pancreas transplantation, Type 1 diabetes S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Dadlani V, Kaur RJ, Stegall M, et al. Continuous glucose monitoring to assess glycemic control in the first 6 weeks after pancreas transplantation. Clin
Background
Transplant candidates are reluctant to accept kidneys from high Kidney Donor Profile Index (KDPI) donors. Incomplete understanding can lead to transplant delays for older transplant candidates. Patients need access to understandable information to make more informed decisions about KDPI.
Methods
We developed a KDPI‐specific animation with input from six stakeholder groups and conducted a one‐group pre‐post study with 60 kidney transplant candidates for feasibility and acceptability to improve participant KDPI knowledge, understanding, decisional self‐efficacy, and willingness to accept a KDPI > 85% kidney. Data were compared using McNemar's test and Wilcoxon signed‐rank test.
Results
Compared with pre‐animation scores, post‐animation scores were significantly higher for KDPI knowledge for the entire cohort (4.6 vs 6.1, P < .001) and across different levels of age, educational attainment, health literacy, vintage, and technology access. The frequency of positive responses increased pre‐post animation for KDPI understanding (55% vs 83%, P < .001) and decisional self‐efficacy (47% vs 75%, P < .001). However, willingness to accept KDPI > 85% kidneys (32% vs 36%, P = .83) increased by 2%. After viewing simplifyKDPI, >90% indicated positive ratings on ease of watching, understanding, and engaging.
Conclusion
In collaboration with stakeholders, an educational animation about KDPI was developed that was well‐received and is promising to impact knowledge.
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