Continuous glucose monitoring in subjects after simultaneous pancreas-kidney and kidney-alone transplantation

Background: Simultaneous pancreas-kidney (SPK) transplantation is an important replacement therapy for individuals with diabetes and end-stage renal disease. Kidney-alone (KA) transplantation is associated with a high incidence of post-transplant diabetes. Methods: This was a cross-sectional study. We studied 48-h glucose concentrations in eight subjects with type 1 diabetes mellitus after SPK transplantation, six subjects post-KA transplantation, and nine healthy controls using the CGMS^® (Medtronic Minimed, Northridge, CA) continuous glucose monitoring system. Results: The 48-h mean glucose concentration was 101±7mg/dL in the SPK subjects, 105±12mg/dL in the KA subjects, and 99±7mg/dL in the healthy controls. The glycemic excursions were higher in the KA group compared to the SPK cohort and healthy controls (P<0.0001). No differences in the incidence of hypoglycemia were detected among the three groups. Significant postprandial hyperglycemia was uncovered in four of the six KA subjects. Conclusions: SPK transplantation is very effective at normalizing glycemic excursions. Unsuspected hyperglycemia was identified in the KA group. The CGMS was a useful ambulatory tool to study glucose profiles in the post-transplant period and may help uncover hyperglycemia undetected by routine laboratory testing.