Practice evaluation of diabetes management in solid organ transplant recipients in resource-constraint country

Abstract

Objective: Post Transplant Diabetes Mellitus (PTDM) is a major concern affecting 10 to 40 percent of solid organ transplant (SOT) recipients. The objective of this audit was to check the compliance of current Diabetes management in SOT recipients at our centre with standards recommended by British Transplant Society (BTS), The Renal Association and Association of British Clinical Diabetologist (ABCD). The secondary objective of this audit was to identify areas of improvement, and make it a quality improvement project.

Methodology: The audit was conducted in a quaternary care Hospital in Lahore. The questionnaire was prepared as per BTS/ABCD recommendations. Retrospective and real time data of total 52 post Living donor Liver transplant (LDLT) and Live related Renal transplant (LRRT) recipients who were admitted or presented to Diabetes OPD was collected using direct interviews, review of confidential files, electronic notes and at times via telephonic conversation with patients.

Results: Total 52 post (SOT) recipients with 56% post liver, 40% post kidney and 4% combined Liver and Kidney Transplants were audited. The total number of patients who had diabetes pre- Transplant were 32.7% (17/52), patients with family history of Diabetes were 21.6% (11/52) and 57.7% (30/52) of patients were HCV positive. About 52% (27/52) of patients were informed about the risk of PTDM. Only 17.6% (3/17) patients who were diabetic prior to Transplant were seen in Diabetes specialist clinic pre-Transplant. A total 56% (23/52) of admitted transplant recipients achieved Target Blood sugars of 198 mg/dl (11 mmol/L) or less. Diabetes specialists reviewed 26.9% (14/52) of SOT recipients during their inpatient stay. Post discharge, 61.5% of patients checked afternoon capillary blood glucose at home and 57% (30/52) of patients had their Blood sugar levels checked in OPD. About 41.8% (18/43) of patients with high blood sugars followed up in Diabetes specialist clinic post-Transplant. Recipients who received structured Diabetic education were 43.1% (22/52). Only 5.7% (3/52) of patients started on Metformin if GFR was >30. Blood pressure control of <130/80 mm of Hg was achieved in 90% (47/52) of patients. Amongst Diabetics pre-transplant, 48% (8/17) were on statins. Compliance to Oral hypoglycemics/ Insulin was seen in 90% of SOT recipients.

Conclusion: We conclude that greater involvement of the Diabetes team and patient education is required for optimum diabetes control that can improve post-Transplant survival, prevent both immediate and long-term complications and health care costs associated with management of these complications.

How to cite this: Atiq Z, Naqvi A, Azhar S, Afroz T, Sandhu S. Practice evaluation of diabetes management in solid organ transplant recipients in resource-constraint country. JPES. 2024;1(1):29-33.