SUN-566 Continuous Glucose Monitoring for Post-Kidney Transplantation in Pre-existing Type 2 Diabetes

Abstract Disclosure: D. Salih Bacha: None. H. Xiao: None. B. James: None. K. Paulus: None. K. Malloy: None. M. Gossman: None. A. Wee: None. Introduction: Diabetes mellitus (DM) is the leading cause of end-stage renal disease (ESRD) and kidney transplantation. While glucose levels can be well-controlled in ESRD due to reduced insulin clearance and decreased renal gluconeogenesis, post-transplant glycemic control often worsens as kidney function normalizes, appetite improves, and anti-rejection medications are started. Posttransplant care necessitates reliable glucose monitoring given frequent changes in prednisone dose, kidney function, and appetite. Continuous glucose monitoring (CGM) offers extensive data compared to finger-stick glucose monitoring, but there is lack of data in the post-transplant period. Our institution’s prednisone taper lasts 55 days, ending with 7.5 mg/day. To guide our insulin adjustments, the primary objective of this study was to assess CGM-derived glucometrics in type 2 DM (T2DM) patients on insulin during prednisone taper post-transplant. Methods: This prospective study enrolled adult T2DM post-kidney transplant patients on insulin, followed for 3 months. Visits were twice weekly for 3 weeks, then biweekly until steroid taper completion. Freestyle Libre 2 or 3 sensors were used. Weight, BMI, CGM metrics, creatinine, eGFR, and glucose were collected at each visit, and HbA1c at baseline and 3 months. Medications, diet, and carbohydrate intake were reviewed. Events such as readmission, rejection, and delayed graft function were documented. Insulin doses were adjusted in clinic by 10-100% based on absolute insulin dose, CGM metrics, prednisone doses and carbohydrate intake. Readmissions, rejection, and delayed graft function were documented. Results: There were 18 patients so far (median age: 62.5 years; 66.7% male; 83.3% white; median BMI 32.1 kg/m²). At baseline, median glucose was 229 mg/dL and median glucose management indicator (GMI) was 8.8%. Estimated mean glucometrics at baseline showed: 7% time in very high range, 31% in high range, 45% in range, and 0% in low/very low range 0%. At 3 months, estimated mean time percentages were: 4% in very high, 25% in high, 64% in range, 1% in low range, and 0% in very low range. Improvement in time in range was not statistically significant, possibly due to current small sample size. Median HbA1c increased from 6.8% to 7.3%. Total daily insulin dose was 49 units at baseline (0.25 unit/kg basal, 0.25 unit/kg prandial) and 57 units at 3 months (0.25 unit/kg basal, 0.26 unit/kg prandial). At 3 months, 61% were prescribed non-insulin DM medication, all GLP-1 agonists. Readmissions occurred in 28%, unrelated to hyperglycemia. Conclusion: CGM-based insulin titration after kidney transplantation showed trends toward improved glycemic control. These findings may inform insulin-dosing protocols in similar prednisone taper regimens. Larger studies are needed to evaluate CGM’s impact on readmissions, rejection, and delayed graft function. Presentation: Sunday, July 13, 2025