Evolution of Glycemic Control and Variability After Kidney Transplant

Abstract

Dysglycemia is very common after renal transplantation, exhibiting a distinct diurnal pattern of afternoon and evening hyperglycemia. The magnitude of hyperglycemia and variability are maximal in recipients with preexisting diabetes and significant in those who go on to develop NODAT. Dysglycemia improves with time.

The Degree of Hyperglycemia Excursion in Patients of Kidney Transplantation (KT) or Liver Transplantation (LT) Assessed by Continuous Glucose Monitoring (CGM): Pilot Study

“…Our study also showed the detailed degree of the increase in glucose levels, although a long-term follow-up over 6 months or at least 1 year is necessary to support our results. Previously, this pattern after KT was reported using CGM [11]; however, to our knowledge, no previous report has compared the glycemic profiles of KT and LT patients.…”

“…The pattern and severity of hyperglycemia in nondiabetic patients may differ from those in patients with preexisting DM. Patients undergoing transplantation may be exposed to several issues, including treatment with immunosuppressive agents such as glucocorticoids [11, 14, 15]. Therefore, in the early posttransplantation period, either glucocorticoid-induced hyperglycemia may occur or poor glucose control including severe glucose fluctuation is common, and the severity of which also depends on the preexisting glucose tolerance state.…”

“…The degree of glucose fluctuation was also assessed in patients with preexisting diabetes with glucose-lowering agents including insulin therapy. EasyGV Version 9.0.R2 was used to calculate the variables of glycemic variability (http://www.easygv.co.uk/), as described previously [10, 11]. To precisely measure glycemic patterns in detail, the following indices of glucose control quality and variability were calculated in addition to the mean and SD values: weighted average glucose values (M-VALUE), high blood glucose index (HBGI), average daily risk range (ADRR), combination of information from mean and SD of all glucose values (J-INDEX), continuous overlapping net glycemic action (CONGA), lability index (LI), mean of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and mean absolute glucose (MAG).…”

Management of metabolic alterations in adult kidney transplant recipients: A joint position statement of the Italian Society of Nephrology (SIN), the Italian Society for Organ Transplantation (SITO) and the Italian Diabetes Society (SID)

“…In addition, bedside capillary glucose !200 and fasting plasma glucose (FPG) measured early after KT identify patients at risk for PTDM [27,28], prompting the need for closer monitoring during follow-up. However, many patients with hyperglycaemia in the early postoperative period show significant improvements both in glycaemic control and variability in the following months [25]. Thus, as previously recognized by a consensus of international experts, a formal diagnosis of PTDM is best made when patients are stable on their likely maintenance immunosuppression, with stable kidney graft function and in the absence of acute infections [4].…”

“…Hyperglycaemia is very common in the early postoperative period after KT [24], with peaks in the afternoon that likely reflect glucocorticoid kinetics [25,26]. In the first 6 weeks after KT, afternoon capillary blood glucose testing might be more sensitive than other tests in detecting patients at risk for PTDM [26].…”