J Korean Endocr Soc.  2006 Oct;21(5):373-381. 10.3803/jkes.2006.21.5.373.

Contributing Factors to Different Natural Courses of Posttansplantation Diabetes Mellitus in Renal Allograft Recipients

Affiliations
  • 1Department of Internal Medicine, Yonsei University College of Medicine, Korea.
  • 2Department of Surgery, Yonsei University College of Medicine, Korea.

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.

Keyword

Natural courses; Posttransplantation diabetes mellitus; Risk factors

MeSH Terms

Allografts*
Body Weight
Diabetes Mellitus*
Female
Glucose Tolerance Test
Humans
Hyperglycemia
Incidence
Kidney Transplantation
Risk Factors
Tacrolimus
Tacrolimus

Figure

  • 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.

  • 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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