Glucose Control in Type 1 Diabetes after Pancreas Transplantation: Does Automated Delivery Offer Comparable Results?
Zahradnická Martina 1, Nemétová Lenka 1, Kahle Michal 2, Vávra David 1, Bém Robert 1, Girman Peter 1, Haluzík Martin 1, Saudek František 3
Affiliations
(1) Diabetes Center, Institute of Clinical and Experimental Medicine, Prague, Czech Republic;
(2) Department of statistics, Institute of Clinical and Experimental Medicine, Prague, Czech Republic;
(3) Center for Experimental Medicine, Laboratory for Pancreatic Islets, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
Pancreas transplantation ensures long-term near-normal glycemic control for patients with type 1 diabetes but transplantation procedure carry risks including surgical complications, infection, graft loss, and the need for long-term immunosuppressive medication Recent technological advancements have included the automated insulin delivery systems (AID), that combine continuous glucose monitoring with insulin pumps to automatically adjust insulin delivery based on real-time glucose readings. In this prospective study, we compared glycemic control outcomes in patients with type-1 diabetes who underwent a simultaneous pancreas-kidney transplantation versus with an AID system.
Patients and methods
As a part of the prospective SIMA SPK study (Eudra CT No. 2019–002240-24) we performed a comparative analysis including parameters from 31 consecutive pancreas–kidney transplantation recipients versus from 377 people using an AID—either MiniMed 780G (n = 200) or Tandem t:slim X2 Control-IQ (n = 177) using an AID system for at least 3 months and reflecting >75% of time using an AID control regimen. Results are presented with 95% confidence intervals (CIs) to provide estimates of effect sizes and their precision. For comparison, P-values are also provided.
Results
Compared to the MiniMed and Tandem AID groups, transplant recipients at one month (mean ± SD: 36 ± 12 days) after pancreas transplantation exhibited significantly lower HbA1c (mean [95% CI]) (38 mmol/mol [36, 40] versus 55 [53, 57], and 56 [55, 57], respectively), lower mean glycemia (6.4 mmol/L [6, 6.8] versus 8.5 [8.3, 8.7] and 8.2 [8.0, 8.4], respectively), and spent more time “in range” (90% [86, 93] versus 72% [70, 74] and 75% [73, 77], respectively). Time below range (glycemia 3.0 – 3.8 mmol/L and < 3.0 mmol/L) did not differ significantly between the transplant and the entire AID group (P = 0.14 and P = 0.86, resp.). Pancreatic graft function remained stable, with HbA1c of 39 ± 4.2 mmol/mol at 3 months, and 39 ± 3.6 mmol/mol at 1 year post-transplantation without the need of exogenous insulin treatment.
Conclusions
In conclusion, our study demonstrates that at 1-month post-transplant, pancreas-kidney transplant recipients exhibit better metabolic control, compared with patients treated with commonly used AID systems. The exception was hypoglycemia, for which the AID systems showed efficacy comparable with that of pancreas transplantation.
Funding Information
This trial was an independent investigator-initiated study funded by the: 1. AZV MZ ČR (NW24-01-00138), Czech Ministry of Health; 2. the project National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, ID Project No. LX22NPO5104), funded by the European Union, Next Generation EU; and 3. supported by MH CZ – DRO (IKEM, IN 00023001)
