Post-transplant glycemic control: one approach does not fit all

“Many patients who receive allogeneic stem cell transplants will have elevated blood sugar levels after the transplant, even if they are not diagnosed with diabetes before the transplant,” says Fred Hutch Cancer Adult Blood and Bone Marrow Transplant Program Medical Director. Director Dr. Marko Miercarek says: center. In a recent study published in Transplantation and cell therapy, Dr. Mielcarek and his team analyzed the association between blood sugar levels and non-relapse mortality in stem cell transplant patients with and without pre-existing diabetes. The cause of increased blood sugar levels after transplantation is not always clear, but medications and changes in nutrition are often responsible. Many patients receive prednisone, an immunosuppressive drug, and receive nutrition through a stomach tube or intravenously after transplantation, which can disrupt blood sugar control.The stem cell transplant group previously study It analyzes the contribution of bad blood sugar (defined as a rise or fall in blood sugar levels, or increased blood sugar variability) to mortality after stem cell transplants performed at Fred Hutch more than a decade ago. According to this study, hypoglycemia is associated with increased mortality after transplantation. “Therefore, our established theory is that keeping post-transplant blood sugar levels as close to ‘normal’ as possible should lead to better transplant outcomes.” Therefore, we work with the University of Washington’s Glucose Management Consulting Services to help manage blood sugar in complex patients. ” Considering the time elapsed since the previous study, Dr. Mielkarek’s team decided to re-evaluate patient outcomes compared to post-transplant glycemic control by taking into account pre-existing diagnoses of diabetes. did.

In the new study, the team conducted a retrospective analysis of more than 1,000 Fred Hutch transplant patients, including approximately 60,000 early post-transplant blood glucose measurements collected over a five-year period. . As previously reported, elevated blood glucose levels measured within 100 days after transplantation were associated with increased nonrelapse mortality. Surprisingly, this association was more pronounced among patients. without it Pre-existing diabetes. Therefore, the patient and Diabetics appear to be relatively protected from the adverse effects of posttransplant hyperglycemia. “The main finding of our analysis is that patients diagnosed with diabetes before transplantation benefited less from tightly controlled post-transplant blood glucose levels than patients without diabetes. We know that in people with poorly controlled diabetes, a sudden drop in blood sugar levels into the normal range (called “relative hypoglycemia”) can trigger a counterproductive stress response. , we hypothesize that this will lead to increased mortality. So this is possible. Avoiding relative hypoglycemia may improve clinical outcomes in patients with severe diabetes, including transplant patients,” says Dr. Mierkarek. “Our data suggest that a one-size-fits-all approach to glycemic control may not be appropriate, as too aggressive a reduction in blood glucose Therefore, this study confirms that lowering blood sugar levels appears to be beneficial in patients without pre-existing diabetes, but in patients with pre-existing diabetes. The response of some patients may be less favorable. Looking to the future, Dr. Mierkarek says, “Prospective studies are needed to define more nuanced and risk-appropriate approaches to hypoglycemia management after blood stem cell transplantation.”