Continuous Glucose Monitoring in a Renal Transplant Setting

Dear Editor,

A 31-year-old female with type 2 diabetes mellitus underwent kidney transplant surgery. Immediately post-operation, a continuous glucose sensor (Abbott, freestyle libre) was placed over the right deltoid region. The reader, a small mobile-phone-like device provided with the sensor was used to measure blood glucose levels. Glucose values were obtained by placing the reader over the sensor. We measured glucose levels hourly for the initial two days, and continuous insulin infusion (Human Actrapid) was administered for glycemic control. Subsequently, glucose levels were monitored every 4 hours, and as per requirement, a long- acting insulin preparation, Solo-star was administered at night. Human actrapid was also given thrice daily before meals as bolus dose, as per requirement. Her postoperative period was uneventful, and she was discharged with a serum creatinine of 0.8 mg/dL. Post-discharge continuous glucose monitoring (CGM) was not required, as her glycemic control had improved.

CGM is a great innovation, especially for those with erratic and fluctuating insulin requirements.¹ It uses its subcutaneous sensors to estimate interstitial fluid glucose levels (usually every 5 minutes) throughout the day and wirelessly transmits the measured real-time data to the reader. This avoids the hassle of finger pricks. Two types are available: intermittently scanned CGM and real-time CGM (rt-CGM). We used the rt-CGM apparatus, which provided data including the time-in-target range, glycemic variability, and glucose management indicator [Figure 1]. The cost of CGM was the same as that of finger-test glucose monitoring.

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Figure 1:

Glycemic metrics of the patient. The colour codes indicate the degree of glucose control. Green indicates good control and red indicates suboptimal control. Mean glucose levels. The symbol indicates that the device was active and measurement was done for specified number of times. Blue color indicates the time period when sensor was active.

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Clinical practice recommendations on glycemic control in renal transplant settings are currently unavailable.^2,3 Jandovitz et al. conducted a randomized control trial comparing finger-test glucose monitoring with CGM for 40 diabetic patients with ESRD undergoing renal transplantation. Clinical outcomes were better in the CGM group.⁴