Tight Glycemic Control Not Helpful after Kidney Transplant

For diabetic kidney recipients, early intensive glycemic control might reduce delayed graft function (DGF) but with a higher risk of rejection….

Dr. Kathie L. Hermayer stated that, "Our trial showed that a blood glucose target of less than 180 mg/dL resulted in a lower incidence of kidney rejection than a blood glucose target of 70-110 mg/dL." "Due to these results, intensive glycemic control at the time of kidney transplantation is not recommended."

Dr. Hermayer of the Medical University of South Carolina in Charleston and colleagues randomly assigned 104 patients with diabetes or impaired glucose tolerance to intensive 70-100 mg/dL blood glucose target with IV insulin, or to a control group with a target of 70-180 mg/dL via subcutaneous insulin.

Intention-to-treat analysis in 93 patients showed statistically similar rates of delayed graft function in the intensive therapy and control groups: 18% and 24%, respectively, according to an October 16 online paper in the Journal of Clinical Endocrinology & Metabolism.

Seven of the nine patients with severe hypoglycemia were in the intensive group (p=0.08).

There were 30 episodes of severe hyperglycemia in 17 individuals. Five were members of the intensive therapy group (11%) and 12 were controls (24%); again, the difference was not significant.

More importantly, nine of the 11 rejection episodes were in the intensive therapy group (p=0.013). All were in patients who did not experience a severe hypoglycemic event.

In their paper, the authors wrote, "Managing glucose levels in the renal transplant patient is challenging. Due to immunosuppressive agents and corticosteroid dosing, insulin dosing is a dynamic process."

Based on their findings, they say they don’t recommend the intensive approach. What they do recommend, concluded Dr. Hermayer, is "further study of underlying mechanisms that may explain these findings."

The Journal of Clinical Endocrinology & Metabolism October 16, 2012 jc.2012-1979