RT Journal Article
T1 Clinical evolution of post-transplant diabetes mellitus.
A1 Porrini, Esteban L
A1 Díaz, Jose M
A1 Moreso, Francisco
A1 Delgado Mallén, Patricia I
A1 Silva Torres, Irene
A1 Ibernon, Meritxell
A1 Bayés-Genís, Beatriz
A1 Benitez-Ruiz, Rocío
A1 Lampreabe, Ildefonso
A1 Lauzurrica, Ricardo
A1 Osorio, Jose M
A1 Osuna, Antonio
A1 Domínguez-Rollán, Rosa
A1 Ruiz, Juan C
A1 Jiménez-Sosa, Alejandro
A1 González-Rinne, Ana
A1 Marrero-Miranda, Domingo
A1 Macía, Manuel
A1 García, Javier
A1 Torres, Armando
K1 insulin resistance
K1 post-transplant diabetes
K1 prediabetes
AB The long-term clinical evolution of prediabetes and post-transplant diabetes mellitus (PTDM) is unknown. 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. 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. 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.
YR 2015
FD 2015-11-03
LK http://hdl.handle.net/10668/9616
UL http://hdl.handle.net/10668/9616
LA en
DS RISalud
RD Apr 9, 2025