Comprehensive Assessment Of Glycemic Control After Pancreas Transplantation

Introduction: Limited data are available about comprehensive metabolic evaluation after Pancreas transplantation (PT) for type 1 diabetes (T1D). Methods: After IRB approval, we prospectively studied 15 PT recipients at least 1 year post transplant. After a screening visit, subjects underwent Dexcom G4 CGM for one week and Mixed Meal Test (MMT) according to standard procedure. Results: PT recipient were 53.1 ± 10.6 years old, F/M 12/3, BMI (Kg/m2) 30.8 ± 6 and mean duration of diabetes was 33 ± 12.3 years with 6 ± 5 (1-17) years mean interval from PT to the study. Twelve patients underwent pancreas transplant alone and three underwent simultaneous pancreas kidney transplantation. Baseline values were Hemoglobin 12.3 ± 1.4 (g/dl), HbA1c 5.4 ± 0.6 %, Albumin 4.0 ± 0.3 g/dl, Fructosamine 233 ± 27 (µmol/L), Fasting Glucose 94.3 ± 17.5 mg/dl, C-peptide 2.5 ± 0.9 (ng/ml), eGFR 56.3 ± 25.5 ml/min and AST 23.4 ± 8.5 U/L. MMT revealed Glucose concentration increased from 90.9 ± 9.6 mg/dl at baseline to 140.6 ± 41.5 mg/dl at 30min followed by 123.2 ± 48.0 mg/dl and 115.2 ± 34.6 mg/dl at 60mins and 120 mins respectively. C-peptide was 2.4 ± 0.7 ng/ml at baseline, peaked to 7.5 ± 5.4 ng/ml at 60 mins and was 6.0 ± 3.6 mins and 5.9 ± 2.4 at 30 and 120 mins respectively with insulin peaking from 13.5 ± 5.5 uIU/ml at baseline to 107 ± 81.6 uIU/ml at 30 mins and 85.8 ± 78 uIU/ml and 42.2 ± 23.2 uIU/ml at 60 mins and 120 mins respectively. CGM analysis revealed mean CGM glucose was 120.4 ± 14.8 with SD 26.2 ± 7.7. Glucose control was excellent with 94 ± 9.2% of readings within 70-180mg/dl and 79.8 ± 17.6% within 70-140 mg/dl. Percentage time < 70 mg/dl and < 54 mg/dl were 1.1 ± 1.1% and 0.1 ± 0.4% respectively. Percentage time > 180 and > 250 mg/dl were 4.8 ± 9.3% and 0.4 ± 0.7% respectively. HBGI, LBGI and ADRR were 1.3 ± 1.6, 0.7 ± 0.5 and 17.4 ± 8.9 respectively. Conclusion: PT recipients demonstrate excellent glucose control on comprehensive assessment one or more years after the procedure. CGM and MMT data are different from normal people. Disclosure R. Kaur: None. C. Reid: None. P. Thapa: None. S. Rizvi: None. S.K. McCrady-Spitzer: None. S. Batthula: None. B.H. Smith: None. P. Dean: None. W.K. Kremers: Research Support; Self; AstraZeneca. A. Kukla: None. M.D. Stegall: None. Y.C. Kudva: Research Support; Self; Dexcom, Inc., Roche Diabetes Care. Other Relationship; Self; Abbott.