Endocrine Abstracts

Objective: To evaluate the impact of different modes of insulin therapy (continuous subcutaneous insulin infusion (CSII) using insulin pump or multiple insulin injections (MII)) on carbohydrate metabolism, the state of the transplant, cardiovascular system, calcium and phosphorus metabolism in patients with type 1 diabetes (DM1) during the 1st year after kidney transplantation (KT).

Materials and methods: The study included patients with DM1 after transplantation i) five patients treated with CSII and ii) five on MII. Mean duration of diabetes in the first group was 24 years (20; 25), the second group – 23 years (21; 23). Posttransplantation period in both groups was comparable 8 months (7; 8).

Results: The mean level of HbA1c in groups before the study did not different: 9.0% (8.0; 9.6) vs 9.3% (9.2; 9.8). When patients were transfer into CSII–HbA1c after 3-6 months was significantly lower in this group –7.5% (7.5; 7.8), while in the group on MII remained the same-9% (7.6; 9.1). In the group with MII continuing-poor glycemic control in one patient (20%) in the control terms diagnosed recurrent diabetic nephropathy at the stage of microalbuminuria-the level of albuminuria was 35 mg/l, reanalysis – 68.0 mg/l. All patients, treated CSII had normal albuminuria. GFR (EPI) in both groups was comparable: 67 ml/min per 1.73 m² (65; 86) and 65 ml/min per 1.73 m² (63; 109) respectively. Diabetic retinopathy mainly proliferative stage after repeated laser panretinal photocoagulation all patients stabilized. Positive dynamics of hemoglobin, parathyroid hormone, calcium phosphorus product, blood pressure did not differ between groups of patients after KT.

Conclusions: The CSII of using insulin pump allows faster and more efficiently reach target values glycemia in patients with DM1 after transplantation, which may improve the control of complications and overall prognosis.