Impact of continuous glucose monitoring on glycemic control and biochemical cardiovascular risk factors in kidney transplant recipients with type 1 diabetes

Aims To compare biochemical risk factors for cardiovascular disease (CVD) in kidney transplant recipients (KTx) with type 1 diabetes (T1D) who used continuous glucose monitoring (CGM) devices or underwent simultaneous kidney and pancreas (SPK) transplantation during long-term follow-up. Materials and methods 22 graft recipients with T1D using CGM (KTx CGM) and 22 patients with T1D after SPK were included in the study. Study groups were matched for age and diabetes duration at the time of transplantation, age at the time of the study, sex, body mass index (BMI), total duration of dialysis therapy, dialysis modality, pretransplant CVD, and rates of kidney re-transplantation. Biochemical markers of glycemic control and risk for CVD were assessed over a 9-11 year follow up period. Results Fasting plasma glucose (FPG) and HbA1c were higher in the KTx CGM versus SPK group (6.5 [4.9; 7.8] vs 4.7 [4.4; 5.6] mmol/L, p<0.01, and 6.7 [5.9; 7.5] vs 5.2 [5.1; 5.4]%, p<0.001, respectively). Total cholesterol (TC) and high-density lipoprotein (HDL) did not differ between groups. Low-density lipoprotein (LDL) concentrations were lower in the KTx CGM vs the SPK group (2.35 ± 0.66 vs 2.96 ± 1.13 mmol/L, p=0.056). Triglyceride values were higher in the KTx CGM vs SPK group (1.29 ± 0.45 mmol/L vs 1.02 ± 0.39 mmo/L, p<0.05). Serum creatinine was higher (122.7 μmol/L vs 87.2 μmol/L, p< 0.01), and estimated glomerular filtration rates (eGFR) were lower (73.8 ± 25.0 vs 51.3 ± 18.6 ml/min.1.73 m2, p< 0.01) in the KTx CGM vs the SPK group. Conclusions Application of CGM technology in kidney graft recipients with T1D enabled good control of glucose levels and allowed for normalization of a number of biochemical risk factors for CVD. Pancreas transplantation remains the optimal procedure in achieving physiological blood glucose levels in T1D kidney recipients.