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Nephrol Dial Transplant. 2016 Mar;31(3):495-505. doi: 10.1093/ndt/gfv368. Epub 2015 Nov 3.

Clinical evolution of post-transplant diabetes mellitus.

Author information

1
Center for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Tenerife, Spain.
2
Nephrology Unit, Fundación Puigvert (FP), Barcelona, Spain.
3
Nephrology Unit, Hospital Val d́Hebron, Barcelona, Spain.
4
Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
5
Nephrology Unit, Hospital Germans Trias y Puyol, Badalona, Spain.
6
Research Unit, Nephrology Unit, Hospital de Cruces, Bilbao, Spain.
7
Nephrology Section, Hospital Nuestra Señora Virgen de las Nieves, Granada, Spain.
8
Nephrology Unit, Hospital Marqués de Valdecilla, Santander, Spain.
9
Research Unit, Hospital Univesitario de Canarias, Tenerife, Spain.
10
Nephrology Unit, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain.
11
Center for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Tenerife, Spain Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.

Abstract

BACKGROUND:

The long-term clinical evolution of prediabetes and post-transplant diabetes mellitus (PTDM) is unknown.

METHODS:

We analysed, in this cohort study, the reversibility, stability and progression of PTDM and prediabetes in 672 patients using repeated oral glucose tolerance tests (OGTTs) for ≤5 years.

RESULTS:

Most patients were on tacrolimus, steroids and mycophenolate. About half developed either PTDM or prediabetes. The incidence of PTDM was 32% and bimodal: early PTDM (≤3 months) and late PTDM. Early PTDM reverted in 31%; late PTDM developed in patients with post-transplant prediabetes. The use of OGTTs was necessary to detect around half of PTDM. Pretransplant obesity was a major risk factor for early PTDM, for its persistence and for late PTDM {odds ratio [OR] 1.18 [95% confidence interval (CI) 1.09-1.28]}. At 3 months, higher HbA1c promoted [OR 2.37 (95% CI 1.38-4.06)], while insulin sensitivity protected against [OR 0.64 (95% CI 0.48-0.86)] late PTDM. At 3 months, 28% had prediabetes; of these, 36% remained stable, 43% normalized and 21% developed late PTDM. Pretransplant obesity [OR 1.20 (95% CI 1.04-1.39)] and higher HbA1c [OR 3.80 (95% CI 1.45-9.94)] at 3 months promoted while insulin sensitivity protected against [OR 0.57 (95% CI 0.34-0.95)] evolution from prediabetes to late PTDM. Immunosuppressive levels or acute rejection did not influence PTDM. Most (84%) of the patients with normal tests at 3 months remained stable without evolving into PTDM; 14% developed prediabetes.

CONCLUSIONS:

PTDM and prediabetes are very common in renal transplantation. Classic metabolic factors like obesity, prediabetes and insulin resistance promote the evolution of PTDM and prediabetes. Patients with normal glucose metabolism rarely develop PTDM. OGTT is necessary to detect PTDM and prediabetes and thus should be included in clinical practice.

KEYWORDS:

insulin resistance; post-transplant diabetes; prediabetes

PMID:
26538615
DOI:
10.1093/ndt/gfv368
[Indexed for MEDLINE]

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