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Title: Clinical evolution of post-transplant diabetes mellitus.
Authors: Porrini, Esteban L
Díaz, Jose M
Moreso, Francisco
Delgado Mallén, Patricia I
Silva Torres, Irene
Ibernon, Meritxell
Bayés-Genís, Beatriz
Benitez-Ruiz, Rocío
Lampreabe, Ildefonso
Lauzurrica, Ricardo
Osorio, Jose M
Osuna, Antonio
Domínguez-Rollán, Rosa
Ruiz, Juan C
Jiménez-Sosa, Alejandro
González-Rinne, Ana
Marrero-Miranda, Domingo
Macía, Manuel
García, Javier
Torres, Armando
Keywords: insulin resistance;post-transplant diabetes;prediabetes
metadata.dc.subject.mesh: Adult
Diabetes Mellitus
Glucose Tolerance Test
Insulin Resistance
Kidney Transplantation
Middle Aged
Odds Ratio
Postoperative Complications
Prospective Studies
Risk Factors
Issue Date: 3-Nov-2015
Abstract: 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.
metadata.dc.identifier.doi: 10.1093/ndt/gfv368
Appears in Collections:Producción 2020

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