1293-P: Diabetes Management at the Time of Renal Transplantation

Abstract

The goal of this retrospective review was to characterize the glycemic status and antihyperglycemic treatments in persons with diabetes (PwD) undergoing renal transplant and to determine whether use of intravenous insulin infusion (IVI) is associated with clinical outcomes. A retrospective review of all adult patients undergoing renal transplantation at a single tertiary referral center from January 1 - December 31, 20 was performed. Results: Of the 292 patients who underwent renal transplantation, 1 (34.6%) had a diagnosis of diabetes. Pre-transplant treatment for diabetes included insulin in 61 (60.4%) , non-insulin medications in (10.9%) , and both insulin and non-insulin medications in 5 PwD (4.9%) . Twenty-four PwD (23.8%) were not taking medications for diabetes. While hospitalized 65 (64.4%) PwD received IVI while the remainder received SC insulin (SCI) . The pooled daily mean point of care (POC) glucose on postoperative day (POD) 0 through POD 3 was not significantly different between IVI vs. SCI (164.5 vs. 165.3mg/dL, p=0.91) . ICU admission occurred in 7 (10.8%) IVI and 8 (22.5%) SCI (OR 0.42, 95% CI 0.14-1.28) . Fourteen (21.5%) IVI and 5 (13.9%) SCI underwent dialysis during hospitalization (OR 1.70, 95%CI 0.56-5.19) . Readmission within 30 days occurred for 17 (26.6%) IVI and 12 (33.3%) SCI (OR 0.53, 95% CI 0.22-1.27) . Discussion: While pre-transplant treatment of diabetes varied, most PwD undergoing renal transplantation were placed on IV insulin for management of hyperglycemia post-transplant. Insulin infusion was not associated with significant differences in pooled daily mean blood glucose. Significant differences in clinical outcomes were not identified between those treated vs. not treated with insulin infusion, but this could be due to the relatively small sample size. More research is needed to understand how diabetes care can be improved in hospitalized PwD undergoing renal transplantation. Disclosure M.Griff: None. S.Crawley: None. A.Rowland: None. S.A.Seggelke: None. R.Hawkins: None. C.C.Low wang: Employee; CPC Clinical Research, Research Support; CellResearch Corporation, Virta Health Corp.