Introduction: Simultaneous pancreas kidney transplant (SPK) is a prime line treatment option in patients with type 1 diabetes and chronic kidney failure. The glucose control during perioperatory period can be a prognostic factor for transplant. Actually, the utility of the continuous glucose monitoring is not well defined. Our objective was to study the utility of a continuous glucose monitoring system during the simultaneous pancreas kidney transplant.
Material and methods: We installed a real time continuous glucose monitoring system (Guardian, Medtronic) to patients transplanted the last 2 years in Carlos Haya Hospital. The system was maintained since 610 h before until 1015 days after transplant. Capillary glucose controls were done (24/day) to calibrate the system. Alarms were programmed for hypo and hyperglycemia. The data aported by the system were used for the perioperatory glucose control and afterwards were discharged using carelink-pro1 program.
Results: Twenty patients received a simultaneous pancreaskidney transplantation. The medium age was 38.08 (2953) years and diabetes duration was 21.66 (1728) years. 83.3% of the patients were in hemodialysis before the transplant (medium of time, 15.1 months). During the monitorization period, mean of capilar glucose was 127.9±34.8 mg/dl (median 121 mg/dl). Interstitial mean glucose from sensor was 127.3±32.2 mg/dl (median 124 mg/dl). A good correlation between capilar and interstitial glucose was observed (R=0.93, P<0.05).
AUC below 70 was 0.12±0.2 and AUC below 140 was 9.9±10.2.
Medical staff in operating room, intensive care and nephrology departments displayed good acceptance and satisfaction with the system. Principal advantages were: avoid doing capilar glicemias hourly and prevent hyper/hypoglycemias. Alarms played an important role in detecting hyperglycemia in these patients for an intensive early treatment.: Conclusions
Real time continuous monitoring could be an effective and useful tool for intensive glycemic control during peritransplant period with good correlation with capilar glucose data.
30 Apr - 04 May 2011
European Society of Endocrinology