Hypoglycemia with insulin in post-transplant diabetes mellitus |
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| Affiliation: | 1. Albany Medical Center, Albany, NY, United States of America;2. George Mason University, Fairfax, VA, United States of America;3. University of Cincinnati Medical Center, Cincinnati, OH, United States of America;4. Erie County Medical Center, Buffalo, NY, United States of America;1. Department of Lung Cancer Surgery, Tianjin Medical University General Hospital; Anshan Road No.154, Heping District, Tianjin 300052, China;2. Department of Pediatric Surgery, Tianjin Children''s Hospital, No.238 LongYan Road, Tianjin 300134, China;3. Department of Genetics, School of Basic Medical Sciences, Tianjin Medical University, Qixiangtai Road, No.22, Heping District, Tianjin 300070, China;1. Peking University People''s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, PR China;2. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, PR China;3. Peking-Tsinghua Center for Life Sciences, Beijing, PR China;1. Student Research Committee, Babol University of Medical Sciences, Babol, Iran;4. Kidney Transplantation Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran |
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| Abstract: | IntroductionTo prevent hypoglycemic episodes, the management of insulin therapy against post-transplant diabetes mellitus (PTDM) is important. We compared glargine (long-acting insulin) versus NPH isophane (intermediate-acting insulin) as an armamentarium against PTDM. Indeed, the study evaluated PTDM patients with hypoglycemic episodes treated with isophane or glargine.Material and methodsWe evaluated a total number of 231 living-donor renal transplant recipients with PTDM of age ≥ 18 years admitted to the hospital between January 2017 and September 2021. However, patients taking hypoglycemic agents before transplantation were excluded from this study. Out of 231 patients, 52 (22.15%) suffered from PTDM out of whom 26 were treated with glargine or isophane.ResultsAfter applying exclusion criteria, out of 52 PTDM patients 23 were included in the study: 13 PTDM patients were treated with glargine, whereas 10 PTDM patients with isophane. Our analysis revealed 12 episodes of hypoglycemia in glargine-treated PTDM patients compared to 3 in isophane-treated PTDM patients (p = 0.056). Clinically, 9 out of 15 hypoglycemic episodes were nocturnal (60%). Furthermore, no other risk factors were observed in our study population. Detailed analysis showed that both groups had equivalent doses of immunosuppressants and oral hypoglycemic agents. The odds ratio for hypoglycemia in the group treated with isophane compared to that treated with glargine was 0.224 (95% CI, 0.032–1.559). Glargine users recorded significantly lower blood sugar levels before lunch, dinner and at bedtime with p-values of 0.001, 0.009 and 0.001 respectively. A better hemoglobin A1c (HbA1c) level was seen in the glargine vs. isophane group (6.98 ± 0.52 vs. 7.45 ± 0.49, p-value 0.03).ConclusionThe study shows better blood sugar control with long-acting insulin analog, glargine, than with intermediate-actin analog, isophane. Overall, a higher number of hypoglycemic episodes was nocturnal. Long term safety of long-acting insulin analogs needs to be further studied. |
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