Clinical transplantation · 2025
Defining Targets for Continuous Glucose Monitoring After Total Pancreatectomy With Islet Autotransplantation.
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Somani Zaynab, Hodges James S, Chinnakotla Srinath, Martin David, Ramanathan Karthik, Beilman Gregory J, Bellin Melena D
Аннотация
INTRODUCTION: Targets for continuous glucose monitoring (CGM) are well established for type 1 and type 2 diabetes. In total pancreatectomy with islet autotransplantation (TPIAT), stricter glycemic targets are needed to avoid metabolic stress on transplanted islets, but no guidelines exist for CGM targets.
METHODS: We aimed to determine CGM targets for TPIAT clinical management by associating CGM metrics with goal hemoglobin A1c (HbA1c) ≤ 6.5%. Targets for time in range (TIR) 70-140, TIR 70-180, mean CGM glucose, and time in hyperglycemia (>140, >180, >250 mg/dL) were chosen to give good sensitivity and specificity for identifying HbA1c ≤6.5%.
RESULTS: We included 256 pairs of 14-day CGM metrics with a concurrent HbA1c value (n = 82 patients, age 35 [IQR 19-46] years at surgery, 70% female) who were ≥0.5 years post TPIAT (median 4.1 years) and wearing Dexcom G6. Most patients had more than one HbA1c and corresponding CGM available (median 2 [IQR 1-4] per patient).
CONCLUSION: We found that TIR 70-140 ≥ 50% and TIR 70-180 mg/dL ≥ 75% may be reasonable minimum targets for patients and providers using CGM data to manage diabetes long-term after TPIAT. Failure to meet these targets should prompt starting or adjusting insulin therapy, especially if hypoglycemia is not a concern.
METHODS: We aimed to determine CGM targets for TPIAT clinical management by associating CGM metrics with goal hemoglobin A1c (HbA1c) ≤ 6.5%. Targets for time in range (TIR) 70-140, TIR 70-180, mean CGM glucose, and time in hyperglycemia (>140, >180, >250 mg/dL) were chosen to give good sensitivity and specificity for identifying HbA1c ≤6.5%.
RESULTS: We included 256 pairs of 14-day CGM metrics with a concurrent HbA1c value (n = 82 patients, age 35 [IQR 19-46] years at surgery, 70% female) who were ≥0.5 years post TPIAT (median 4.1 years) and wearing Dexcom G6. Most patients had more than one HbA1c and corresponding CGM available (median 2 [IQR 1-4] per patient).
CONCLUSION: We found that TIR 70-140 ≥ 50% and TIR 70-180 mg/dL ≥ 75% may be reasonable minimum targets for patients and providers using CGM data to manage diabetes long-term after TPIAT. Failure to meet these targets should prompt starting or adjusting insulin therapy, especially if hypoglycemia is not a concern.
Предметные рубрики MeSH
HumansPancreatectomyFemaleIslets of Langerhans TransplantationMaleMiddle AgedAdultBlood GlucoseFollow-Up StudiesTransplantation, AutologousPrognosisYoung AdultBlood Glucose Self-MonitoringGlycated HemoglobinDiabetes Mellitus, Type 1BiomarkersDiabetes Mellitus, Type 2Retrospective StudiesHyperglycemiaContinuous Glucose Monitoring