Journal List > J Korean Endocr Soc > v.21(5) > 1003316

Hur, Kim, Nam, Kang, Lee, Kim, Han, Cha, Ahn, Kim, Kim, and Lee: Contributing Factors to Different Natural Courses of Posttansplantation Diabetes Mellitus in Renal Allograft Recipients

Abstract

Background

New onset diabetes is a major complication after kidney transplantation. However, the natural course of posttransplantation diabetes mellitus (PTDM) remains unclear. The aim of this study was to demonstrate the detailed natural courses of PTDM according to the onset and persistency of hyperglycemia, and to investigate risk factors for development of different courses of PTDM in renal allograft recipients.

Methods

A total of 77 renal allograft recipients without previously known diabetes were enrolled and performed a serial 75 g oral glucose tolerance test at 0, 1, and 7 years after kidney transplantation. Patients were classified according to the onset and persistency of PTDM: early PTMD (E-PTDM), late PTDM (L-PTDM), persistent PTDM (P-PTDM), transient PTMD (T-PTDM), and non-PTDN (N-PTDM).

Results

The incidence of each group was as follows: E-PTDM, 39%; L-PTDM, 11.7%; P-PTDM, 23.4% T-PTDM, 15.6%; N-PTDM, 49.3%. Tacrolimus and female gender were associated with the development of E-PTDM. Among E-PTDM, age at transplantation was a high risk factor for the development of P-PTDM. Higher BMI at year1 was associated with the development of L-PTDM.

Conclusion

Different risk factors were associated with various natural courses of PTDM. Since old age and female gender are not modifiable risk factors, it may be important to modify immunosuppressive therapy regimens for the prevention of E-PTDM and control of body weight for L-PTDM.

Figures and Tables

Fig. 1
Different clinical courses of posttransplantation diabetes mellitus (PTDM) in renal allograft recipients. E-PTDM, early PTDM NGT; L-PTDM, late PTDM NGT, normal glucose tolerance; N-PTDM, non-PTDM until 7 year posttrnasplant; P-PTDM, persistent PTDM; T-PTDM, transient PTDM.
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Fig. 2
Serial changes in insulin secretion, SecrAUC (A), insulin sensitivity (ISI) (B), ΔSecrAUC (C), and ΔISI (D). ISI, insulin sensitivity index (µmolkg-1ㆍmin-1pmol-1); ΔISI, ISI (at year 1 or 7) - ISI (at baseline); L-PTDM, late posttransplantation diabetes mellitus (PTDM); N-PTDM, non-PTDM until 7 year posttransplant; P-PTDM, persistent PTDM; SecrAUC, index of β-cell function (SecrAUCInsulin / SecrAUCGlucose); ΔSecrAUC, SecrAUC (at year 1 or 7) - SecrAUC (at baseline); T-PTDM, transient PTDM.
*P < 0.05 compared with N-PTDM at each time point by the Kruskal-Wallis test.
**P < 0.001 compared with N-PTDM at each time point by the Kruskal-Wallis test.
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Table 1
Baseline clinical characteristics in E-PTDM vs. non-PTDM
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Data are means ± SD or n (%) unless otherwise indicated.

E-PTDM, early posttransplantation diabetes mellitus (PTDM); HCV, hepatitis C virus FPG, fasting plasma glucose SecrAUC, index of β-cell function (SecrAUCInsulin / SecrAUCGlucose); ISI, insulin sensitivity index (µmolkg-1ㆍmin-1 pmol-1).

*Family history of diabetes in a first-degree relative.

Table 2
Immunosuppressive agent regimen
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Data are n (%).

CsA, cyclosporine A; E-PTDM, early posttransplantation diabetes mellitus (PTDM); L-PTDM, late PTDM; MMF, mycophenolate mofetil; N-PTDM, non-PTDM until 7 year posttransplant; P-PTDM, persistent PTDM; T-PTDM, transient PTDM.

Table 3
Multivariate analysis of risk factors for early PTDM vs. non-PTDM at baseline
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E-PTDM, early posttransplantation diabetes mellitus (PTDM); MMF, mycophenolate mofetil; FPG, fasting plasma glucose.

*Family history of diabetes in a first-degree relative.

Table 4
Clinical characteristics of different courses of PTDM at 1 year posttransplant
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Data are means ± SD or n (%) unless otherwise indicated.

CsA, cyclosporine A; E-PTDM, early posttransplantation diabetes mellitus (PTDM); FPG, fasting plasma glucose HCV, hepatitis C virus; ISI, insulin sensitivity index (µmolkg-1min-1pmol-1); L-PTDM, late PTDM; MMF, mycophenolate mofetil. N-PTDM, non-PTDN until 7 year posttransplant; P-PTDM, persistent PTDM; SecrAUC, index of β-cell function (SecrAUCInsulin / SecrAUCGlucose); T-PTDM, transient PTDM.

*Family history of diabetes in a first-degree relative.

data are at 1 year posttransplant.

Table 5
Multivariate analysis of risk factors for P-PTDM vs. T-PTDM and L-PTDM vs. N-PTDM at 1 year posttransplant
jkes-21-273-i005

L-PTDM, late posttransplantation diabetes mellitus (PTDM); N-PTDM, non-PTDM until 7 year posttransplant; P-PTDM, persistent PTDM; T-PTDM, transient PTDM.

*Family history of diabetes in a first-degree relative.

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