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Pediatr Diabetes. 2018 Nov;19(7):1191-1197. doi: 10.1111/pedi.12725. Epub 2018 Aug 22.

Diabetes mellitus in pediatric solid organ recipients without and with cystic fibrosis: An analysis from the German-Austrian diabetes database (Diabetes Patienten Verlaufsdokumentation).

Author information

1
Department of Pediatric Endocrinology and Diabetology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany.
2
Department of Pediatrics, Saarland University Medical Center, Homburg/Saar, Germany.
3
Department of Pediatric Endocrinology and Diabetology, Charité University Medicine Berlin, Berlin, Germany.
4
Department of Pediatrics, University Hospital Innsbruck, Innsbruck, Austria.
5
Department of Pediatrics, Hannover Medical University, Hannover, Germany.
6
Division of Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Gießen, Germany.
7
Department of Pediatrics, Elisabeth Krankenhaus Essen, Essen, Germany.
8
Medical University of Cologne, Köln, Germany.
9
Department of Pediatric Cardiology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany.
10
Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
11
German Center for Diabetes Research (DZD), Neuherberg, Germany.

Abstract

INTRODUCTION:

Posttransplantation diabetes mellitus (PTDM) increases the risk of cardiovascular disease, graft loss, and decreased survival. Follow-up treatment after solid organ transplantation (SOT) needs to focus on, inter alia, maintaining balanced glucose metabolism. This study aimed to ascertain the prevalence of PTDM and describe patient characteristics in the large DPV (Diabetes Patienten Verlaufsdokumentation) pediatric diabetes database.

METHODS:

DPV data of 71 902 patients from the January 01, 1995 to January 04, 2015 period were analyzed for patients with and without cystic fibrosis (CF) after SOT (kidney, liver, heart, and lung). Multivariable analysis served to assess differences between SOT patient groups at risk for developing diabetes.

RESULTS:

Out of 109 SOT patients, 51 had CF; 72.5% received steroids and 62% were additionally given tacrolimus. PTDM developed in 45% of CF patients and 12% of non-CF patients. SOT patients were older at diabetes onset (mean age, 12.50 ± 3.98 years), shorter (height z-score, -1.67 ± 1.25), and lighter (weight z-score, -1.59 ± 1.57) than non-SOT diabetes patients (P < 0.01). With transplantation, glycated hemoglobin (HbA1c) was significantly lower and treatment for hypertension and dyslipidemia was increased. Among SOT patients, weight and body mass index (BMI) z-scores were significantly lower in patients with CF-related diabetes (P < 0.05).

CONCLUSIONS:

SOT was present in 6.6% of children with diabetes, and this might aggravate the risk of cardiovascular disease in populations with already increased rates of hypertension and dyslipidemia. Dystrophy and short stature were also present, particularly in transplant recipients with CF and diabetes. Comorbidities and long-term consequences call for multidisciplinary collaboration.

KEYWORDS:

children; cystic fibrosis; diabetes; tacrolimus; transplantation

PMID:
30070005
DOI:
10.1111/pedi.12725

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