Continuous Gloucose Monitoring in post op Pancreas Transplant

Diabetes Mellitus affects approximately 2.6million people in the UK (15% type 1 and 85% type 2) with a further 50% likely to be undiagnosed.  It is the biggest single cause of end-stage renal failure (ESRF), and is associated with 20- 25% of hospital admissions.

Pancreas Transplantation (PT) is the gold standard management for patients with Insulin Dependent Diabetes Mellitus (IDDM) and end-organ failure. It ensures a return to normal physiological control of blood glucose. In 80% of cases it is performed simultaneously with a kidney transplant, providing a treatment for ESRF. Approximately 200 PT’s are performed each year in the UK.

PT is associated with 50% post-operative morbidity and 25% re-operation rate. One-year graft survival is 85%, the majority being lost in the immediate post-operative period due to vascular complications, which account for 70% of technical graft failures. All patients are transferred to critical care for high-intensity monitoring of vital observations and blood sugar.

Monitoring of blood sugar is the only method we possess to monitor pancreatic function and is done according to a complex protocolised approach on a centre-by-centre basis. Commonly, blood gas analysis and/ or bed-side monitoring blood glucose machines are used by the nursing staff to measure blood glucose at allocated times post-operatively. Although this method of monitoring is very specific to graft loss, sensitivity is low. Intermittent blood glucose analysis often misses the initial rise in serum glucose, meaning that, when detected, it is too late and the graft is unsalvageable.

Diabetes Mellitus affects approximately 2.6million people in the UK (15% type 1 and 85% type 2) with a further 50% likely to be undiagnosed.  It is the biggest single cause of end-stage renal failure (ESRF), and is associated with 20- 25% of hospital admissions.

Pancreas Transplantation (PT) is the gold standard management for patients with Insulin Dependent Diabetes Mellitus (IDDM) and end-organ failure. It ensures a return to normal physiological control of blood glucose. In 80% of cases it is performed simultaneously with a kidney transplant, providing a treatment for ESRF. Approximately 200 PT’s are performed each year in the UK.

 

PT is associated with 50% post-operative morbidity and 25% re-operation rate. One-year graft survival is 85%, the majority being lost in the immediate post-operative period due to vascular complications, which account for 70% of technical graft failures. All patients are transferred to critical care for high-intensity monitoring of vital observations and blood sugar.

 

Monitoring of blood sugar is the only method we possess to monitor pancreatic function and is done according to a complex protocolised approach on a centre-by-centre basis. Commonly, blood gas analysis and/ or bed-side monitoring blood glucose machines are used by the nursing staff to measure blood glucose at allocated times post-operatively. Although this method of monitoring is very specific to graft loss, sensitivity is low. Intermittent blood glucose analysis often misses the initial rise in serum glucose, meaning that, when detected, it is too late and the graft is unsalvageable.