Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Uncontrolled post-transplant hyperglycemia (PTHG) can result in post-transplant diabetes mellitus (PTDM), therefore strict control of PTHG is warranted. PTDM affects 10-40% of transplant recipients and increases morbidity and mortality.
Research Question or Hypothesis: Does pharmacy-led management of PTHG through a collaborative practice agreement (CPA) improve glycemic control?
Study Design: Retrospective review of adults =18 years who received a kidney or liver-kidney transplant between 1/2014-12/2015 and 4/2021-10/2022 in the pre- and post-CPA groups, respectively.
Methods: Inclusion criteria were patients discharged or started on anti-hyperglycemic agents within 30 days of transplant with 1 year of follow-up. Patients with Type 1 Diabetes Mellitus, insulin pump, other organ transplants, or treatment with high-dose corticosteroids for rejection were excluded.
The primary outcome was a composite of hospitalizations and emergency department (ED) visits within 6 months from transplant due to PTHG. Secondary outcomes included hemoglobin A1c (HgbA1c) <7% and discontinuation of insulin at 6- and 12-months post-transplant, and time to first documented ambulatory PTHG assessment. Data were reported with descriptive statistics.
Results: Fifty-one and 53 patients in the pre- and post-CPA groups were included, respectively. Transplant pharmacy followed all patients in the post-CPA group. There were no differences in baseline demographics except tacrolimus formulation, inpatient diabetes consults on initial admission, and baseline HgbA1c between groups.
The primary outcome occurred in 3 patients (5.9%) and no patients in the pre- and post-CPA groups, respectively. More patients in the post-CPA group achieved a HgbA1c <7% at 6-months (31.7% vs. 68.1%; p=0.007) and 12-months (22.7% vs. 58.3%; p=0.004) using the last HgbA1c carried forward. More patients in the post-CPA group discontinued insulin at 12-months (7.1% vs. 30%; p=0.02) and all anti-hyperglycemic agents by 6-months (2% vs. 15.1%; p=0.02).
Conclusion: The transplant pharmacy-led service numerically reduced hospitalizations and ED visits due to PTHG, and less insulin use at 1-year post-transplant.
Presenting Author
Kevin Ho PharmDYale New Haven Hospital
Authors
Kristen Belfield PharmD
Yale New Haven Hospital
Elizabeth Cohen PharmD
Yale-New Haven Hospital
Vincent Do PharmD
Yale New Haven Hospital
Gianna Girone PharmD
Yale New Haven Hospital
Jennifer Marvin PharmD
Yale New Haven Hospital