A prospective randomized study comparing the impact of twice divided versus once daily prednisolone dosing on hyperglycemia and glycemic variability among renal transplant patients
Journal Title: Medpulse International Journal of Medicine - Year 2019, Vol 9, Issue 3
Abstract
Aim: Prednisolone exerts high glycemic variability leading to endothelial dysfunction and coronary events. This study compares glycemic excursions, hypothalamic–pituitary–adrenal axis suppression, sleep disturbance, lipid profile between divided twice daily (BD) and once daily (OD) prednisolone groups. Materials and Methods: Thirty-two renal transplant recipients without diabetes were randomized to BD or OD prednisolone. Two hepatitis C positive patients under BD group and three serology negative patients from OD group developed NODAT and hence excluded. One BD group patient suffered graft nephrectomy and was excluded. After three weeks post-transplant, 4th hourly venous glucose monitoring was performed for 3 days. Mean glucose, highest glucose and lowest glucose, exposure to hyperglycaemia, glycemic variability and HbA1C levels were assessed. 8AM serum cortisol, lipid profile, Athens Insomnia score, creatinine, sodium, potassium, urine culture and sensitivity were also assessed. Results: Median age was 32yrs, 88.43% were males. Mean tacrolimus level [between 8-12 ng/ml (P< 0.512)] and mean glucose(P<0.68) among both groups were similar. BD group has less higher glucose value [206 versus 216 (P<0.007)] and exposure to hyperglycaemia ≥180mg/dl [4(30.8%) versus 11(84.6%) patients(P=0.034)]. Glycemic variability scores MAGE (P=0.0007), CONGA (P=0.0009), J-index (P=0.007) and Mean absolute glucose (P=0.0001), mean HbA1C (P=0.026), creatinine (P=0.016), cholesterol (P=0.665), triglycerides (P=0.112), LDL (P=0.243), VLDL (P=0.398), cholesterol/HDL ratio (P=0.717), urinary tract infections were less with BD group. HDL (P=0.605) was more with BD group. Fasting cortisol was suppressed in both groups (P=0.285). No difference noted in hemoglobin (P=0.379), sodium (P=0.942), potassium (P=0.166), Athens Insomnia score (P=0.19). Conclusions: Divided prednisolone dosing reduces glycemic variability and hyperglycemia early post-transplant period. HbA1C was lower in the divided dose group. BD group patients have not developed NODAT except those with Hepatitis C infection. Fasting serum cortisol level appears suppressed in OD group also. Athens insomnia score showed no sleep disturbance among both groups
Authors and Affiliations
Shanmugasundaram A, Shivakumar D
Keywords
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- EP ID EP517173
- DOI 10.26611/10219313
- Views 29
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