The metabolic control with insulin pump use in Post-Transplant Diabetics - An Indian Experience

Dr Kiraninder Singh Brar; Dr Naresh Bansal; Dr MK Garg

Volume : VIII, Issue : IV, April - 2019

The metabolic control with insulin pump use in Post-Transplant Diabetics - An Indian Experience

Dr Kiraninder Singh Brar, Dr Naresh Bansal, Dr Mk Garg

Abstract :

Introduction: There has been an increase in the prevalence of post–transplant diabetics secondary to various organ transplants. The experience with pump use is limited in this subset of diabetics. This study was undertaken to compare the metabolic control in patients with post–transplant Diabetes Mellitus with the use of insulin pumps as compared to conventional insulin therapy. Materials and Methods: This was an open label pilot study done at a tertiary care hospital in India. A total of 11 patients with New Onset Diabetes Mellitus After Transplant (NODAT), aged between 30 – 65 yr, were included in this study. All patients were started on Multiple Subcutaneous Insulin Injections (MSII) on entry in the study and followed up for six months after which period they were placed on Continuous subcutaneous insulin infusion (CSII) via insulin pump for 6 months with monthly follow up. During the follow up visits, the investigators based on self–monitoring of blood glucose, made insulin dose adjustments, hypoglycemic episodes were enquired and weight was recorded. HbA1c and lipid profile was done every three months during the study period. Insulin dose were assessed at each visit. The Insulin Delivery System Rating Questionnaire (IDSRQ), a validated PRO instrument that assesses treatment preference and satisfaction, was completed at baseline, end of six months and study end. The statistical analysis was done using paired t tests and differences between groups on study end outcome measures were assessed using analysis of covariance (ANCOVA). Results: The mean (+SEM) HbA1C values at baseline were 8.7 + 0.6% at the beginning, 8.2 + 0.1% after six months of initiation on MSII therapy and 7.2 + 0.3% after another six months of therapy with CSII respectively. The mean (+SEM) weight gain was 0.9 ± 0.3 kg for the MSII group and 0.7 + 0.2 kg for the CSII group. The initial mean (+SEM) basal insulin doses were 54.5 + 1.4 units and 44.4 + 1.1 units for the MSII and CSII groups, respectively. Two patients in the MSII group and no patient in the CSII group reported severe hypoglycemia, three episodes of Hyperglycemic hyperosmolar state (HHS) in the MSII group and two episodes in the CSII group were noted during the study period. The reduction in total cholesterol, LDL cholesterol and triglycerides was significantly more in CSII group compared to baseline after six months. HRQOL and treatment satisfaction levels revealed patient preference for insulin pump therapy. Conclusion: Better glycemic control with reduced insulin requirement, lesser weight gain, better lipid profile and higher levels of patient satisfaction can be achieved with CSII when compared to MSII therapy without increasing the incidence of severe hypoglycemic episodes.