Korean J Transplant.  2023 Nov;37(Suppl 1):S90. 10.4285/ATW2023.F-6726.

A comparison between continuous glucose monitoring and capillary blood glucose monitoring for predicting new-onset diabetes after kidney transplantation

• Shin J
• Jo EA
• Cho A
• Ko M
• Woo HY
• Han A
• Ha J
• Kim S
• Min S

• KMID: 2551677
• DOI: http://doi.org/10.4285/ATW2023.F-6726

Abstract

Background
New-onset diabetes after kidney transplantation (NODAT) is a common and significant complication that nega-tively impacts graft and patient survival. Perioperative continuous glucose monitoring (CGM) has been proposed as a means to predict patients with high risk for NODAT. We have completed a follow-up for the Seoul National University kidney transplanta-tion (KT) CGM study, previously presented as an interim report.
Methods
From the patients in our prospective observational study, we selected 60 patients who were nondiabetic before the transplant and had a 6-month complete follow-up posttransplantation. We analyzed the risk factors for NODAT occurrence and compared the predictive power of CGM and capillary blood glucose (CBG) monitoring for NODAT occurrence.
Results
A total of 14 patients (23.3%) developed NODAT. The NODAT patients were older, more prominent in male, revealed higher mean tacrolimus level during hospitalization and at the time of discharge compared to non-NODAT patients. Preoper-ative CGM showed that NODAT patients had higher mean glucose levels, glucose management index and daily peak glucose levels. Postoperative CBG and CGM showed higher mean glucose levels, and daily peak glucose in NODAT patients. Further-more, postoperative CGM revealed higher rate of time with blood sugar levels exceeding 180 mg/dL in NODAT patients. Multi-variate analysis showed that preoperative risk factors for NODAT were male (odds ratio [OR], 22.68; 95% confidence interval [CI], 1.64–313.95; P=0.020) and preoperative daily peak glucose level (OR, 1.072; 95% CI, 1.009–1.138; P=0.023). Postoperative risk factors were mean glucose level (OR, 1.070; 95% CI, 1.009–1.135; P=0.025) and mean daily peak glucose level (OR, 1.065; 95% CI, 1.010–1.122; P=0.020). We compared the predictive power for NODAT using CBG and CGM models, and the CGM model demon-strated more sensitive (area under the curve, 0.938 vs. 0.862).
Conclusions
Male patients with higher preoperative daily peak glucose level and higher postoperative mean and daily peak glucose level showed increased risks for NODAT. The use of perioperative CGM may be useful in predicting the occurrence of NODAT.