Korean J Transplant.  2022 Nov;36(Supple 1):S159. 10.4285/ATW2022.F-2779.

Detecting high risk patients for new-onset diabetes after transplantation after kidney transplantation using continuous glucose monitoring device

• Jo EA
• Min S
• Han A
• Ha J
• Cho A
• Woo HY

• KMID: 2535675
• DOI: http://doi.org/10.4285/ATW2022.F-2779

Abstract

Background
Perioperative hyperglycemia is common in kidney transplantation and is associated with not only renal allograft outcomes, but also increased risks for development of new-onset diabetes after transplantation (NODAT). The purpose of this study was to identify risk factors associated with NODAT using perioperative continuous glucose monitoring.
Methods
A prospective observational study starting May 1, 2021, was conducted for patients who underwent living donor kidney transplantation. Upon enrollment, a continuous glucose monitoring (CGM) system was applied and CGM was undertaken 2 weeks preoperatively and 2 weeks postoperatively. No additional interventions were undertaken. Clinical characteristics and transplant related outcomes were collected along with glucose profile using the CGM system.
Results
A total of 100 patients were enrolled in the study and completion of both preoperative and postoperative CGM was accomplished in 69 patients. Excluding 13 patients with underlying diabetes, 14 (20.3%) patients developed NODAT and 42 (60.8%) patients did not (nonNODAT). The underlying characteristics of patients that developed NODAT compared to nonNODAT were older (56.1±9.7 vs. 45.4±13.0; P=0.006), more likely male (56.1% vs. 78.6%; P=0.044) and had younger kidney donors (42.7±13.1 vs. 50.8±12.1; P=0.038). The preoperative metabolic lab values of NODAT patients showed higher baseline HbA1c (5.5±0.5 vs. 5.5±0.4; P=0.044) and lower baseline HDL levels (37.6±10.6 vs. 51.5±16.5; P=0.005). The preoperative and postoperative CGM showed higher mean daily peak glucose levels in NODAT patients (preoperative 119.8±14.6 vs. 107.0±15.9; P=0.012 and postoperative 166.4±26.9 vs. 137.5±25.5; P=0.001).
Conclusions
Despite the normal ranges of serum glucose levels or HbA1c, kidney transplant patients who develop NODAT have significantly higher preoperative and postoperative mean daily peak glucose values detected through CGM.