Clinical evolution of post-transplant diabetes mellitus
| Autor: | Armando Torres, Esteban Porrini, Francisco Moreso, Meritxell Ibernon, Irene Silva Torres, Alejandro Jiménez-Sosa, Manuel Macía, Rocío Benitez-Ruiz, Ildefonso Lampreabe, Javier García, Antonio Osuna, José Manuel López Osorio, Beatriz Bayés-Genís, Jose M. Díaz, Domingo Marrero-Miranda, Rosa Domínguez-Rollán, Ricardo Lauzurrica, Ana González-Rinne, Juan Carlos Ruiz, Patricia Delgado Mallén |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty 030232 urology & nephrology prediabetes 030230 surgery Gastroenterology 03 medical and health sciences 0302 clinical medicine Insulin resistance Postoperative Complications Risk Factors Diabetes mellitus Internal medicine insulin resistance medicine Diabetes Mellitus Odds Ratio Humans Prediabetes post-transplant diabetes Prospective Studies Risk factor Transplantation business.industry Incidence (epidemiology) Incidence Odds ratio Glucose Tolerance Test Middle Aged medicine.disease Kidney Transplantation Endocrinology Nephrology Spain Female Insulin Resistance business Cohort study |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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