SUN-133 Glycemic Control in T1D Subjects before and after Pancreas Transplantation

Type 1 diabetes (T1D) is characterized by significant glycemic variability (GV) with current insulin based therapeutic options. Pancreas transplantation (PT) is performed in certain individuals with T1D with and without and end-stage renal disease. To date, GV before and after PT has been examined to a limited extent and the optimal times to assess glucose control after PT has not been evaluated. We investigated GV using continuous glucose monitoring (CGM) prior to PT and 3-6 weeks after PT in 6 patients with T1D. Participants wore CGM for about 4-7 days. Glucose control was measured for the same 6 patients with T1D before PT (age 36.8 ± 9.8 years, F/M 3/3, HbA1c 8.2 ± 0.9%, BMI 26.8 ± 4.8 kg/m(2) and creatinine 3 ± 2.3 mg/dl) and 3-6 weeks after PT (HbA1c 6.8 ± 1.3%, BMI 25.5 ± 5 kg/m(2) and creatinine 1.5 ± 0.7 mg/dl). The CGM data were analyzed using measures of glucose control as recommended by the recent consensus report. Measurements include standard measures such as mean ± SD and state of the art CGM related statistics such as % time spent in various glucose ranges and indices of hypo and hyperglycemia. Mean CGM glucose improved after PT compared to before PT (136.5 ± 27.3 vs 199.5 ± 36.5, P value 0.01). The percentage of time spent within ranges 70-180mg/dl and 70 -140mg/dl after PT was 84.8 ± 13.7% and 61± 27.3% compared to before PT 42.5 ± 15.4% and 21.5 ± 10.1 (P value 0.004 and 0.02 respectively). Significant change was noticed in duration of hyperglycemia as percentage of time spent above 180mg and 250mg/dl were higher prior to PT (55 ± 17.2 and 23.8 ± 17.4% respectively) compared to after PT 14.3 ± 14.1% and 2.2 ± 3% respectively (P value 0.006 and 0.03). Hypoglycemic episodes during CGM were observed in patients before but not after PT. 4 patients had episodes of hypoglycemia <54mg/dl before PT and total percentage of time < 54mg/dl was 0.7 ± 0.8 and < 70mg/dl 2.7 ± 2.7 before PT. Patients after PT showed improvement in hypoglycemia with percentage time spent <70mg/dl 0.7 ± 0.5% (P value 0.1) and no time<54mg/dl (P value 0.1) Similar results were observed when data were analyzed for daytime and nighttime glucose control. However, hypoglycemia was observed more during nighttime (12-6am) than during daytime before PT (3.5 ± 3.2 vs 2.6 ± 6.4) and after PT (2.2 ± 2.6 vs 0.9 ± 1.1). Conclusion: CGM provides a reliable method of monitoring glucose control after pancreas transplantation. Overall glucose control measures were better after PT even with a sample size of 6 subjects. CGM outcomes represent an important objective outcome of glucose control after PT and require inclusion in prospective studies of PT with appropriate times for measurement to be investigated further.