Glycemic management after kidney transplantation remains challenging in patients with type 2 diabetes mellitus (T2DM) because of corticosteroid exposure and metabolic changes associated with immunosuppressive therapy. A pilot study published in Clinical Transplantation evaluated whether a continuous glucose monitor (CGM)-guided insulin titration protocol could improve glycemic control during prednisone taper after kidney transplantation. 

The study enrolled kidney transplant recipients with pre-existing T2DM receiving insulin therapy. CGM metrics were used to guide insulin dose adjustments over 3 months, with follow-up data collected through 6 months. Investigators assessed glucometric outcomes, insulin dosing, prednisone exposure, kidney function, and clinical outcomes.

Findings

• Time in range (TIR) increased from 44.2% at baseline to 60.8% at 3 months (P = 0.005) and to 72.9% at 6 months (P < 0.001).
• Average glucose declined from 194.7 mg/dL at baseline to 160.6 mg/dL at 3 months and 148.0 mg/dL at 6 months (P < 0.001).
• Time below range (TBR) 54-69 mg/dL remained low, increasing from 0.3% at baseline to 0.4% at 3 months and 0.6% at 6 months.
• No significant increase in severe hypoglycemia (TBR <54 mg/dL) was observed during follow-up.
• Mean total insulin dose increased from 0.48 units/kg at baseline to 0.66 units/kg at 3 months before decreasing to 0.56 units/kg at 6 months.

CGM-guided insulin titration during prednisone taper after kidney transplantation improved glycemic control in patients with T2DM while maintaining low rates of clinically significant hypoglycemia.