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Correlation of Pretransplant Glucose Metabolism With the development of New Onset Diabetes After Renal Transplantation

Bagai, Sahil1; Rao, Namrata1; Sharma, Ashish2; Sachdeva, Naresh3; Rathi, Manish1

doi: 10.1097/01.tp.0000520381.37312.91
212.7
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1Nephrology, PGIMER, Chandigarh, India;

2Renal Transplant Surgery, PGIMER, Chandigarh, India;

3Endocrinology, PGIMER, Chandigarh, India.

Introduction: NODAT is a strong independent predictor of mortality (1). Several modifiable and non-modifiable risk factors for NODAT exist. The aim of this study was to analyze influence of pre-transplant glucose metabolism on development of NODAT.

Methods: CKD-ESRD patients who underwent renal transplantation in a single center were included in the study. Total of 114 patients who met the inclusion criteria were enrolled. Demographic data were collected; anthropometric variables such as body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio were measured according to a standard protocol. Measurements of plasma glucose in the fasting state and 2 hours after ingestion of 75 g glucose were done. Diabetes and abnormal glucose tolerance were defined according to ADA criteria. Fasting insulin and c-peptide were done using ELISA based kits. HOMA model was used to define beta cell function and insulin resistance (2). Insulin resistance (IR) = (FI x G)/22.5 Beta cell function (B) = (20 x FI)/(G −3.5) Insulin sensitivity (IS) = 100/IR; FI = fasting insulin (μIU/ml), and G = fasting glucose (mmol/l). NODAT was defined using International Consensus Guidelines. In this study correlation of pre-transplant glucose parameters (FBS, 2 hr PPBS), HbA1c and Insulin resistance using HOMA model, C-peptide done were followed in post-transplant period to see for the development of NODAT. Also, correlation if any between pre-transplant anthropometric parameters and NODAT were studied.

Results: NODAT developed in 33 (28.9%) of patients. Mean age of study group was 32.84 ± 9.37 years. Pre-transplant fasting blood glucose values were significantly higher in group that later developed NODAT (85.24 ± 10 vs 81.84 ± 7.76, p = 0.054). Also, 2 hr plasma glucose was found to be higher in group that developed NODAT (133.58 ± 34.64 vs 114.49 ± 25.21, p = 0.010). Insulin resistance was high in pre-transplant period in patients with NODAT (1.49 ± 1.16 vs 1.05 ± 0.86, p = 0.021). Weight, BMI, Waist circumference, hip circumference, Wc/Hc, HbA1c, c-peptide were found to be insignificant in predicting development of NODAT. Gender, basic disease, dialysis duration had no bearing on development of NODAT.

Conclusion: In our center pre-transplant glucose parameters like FBS, OGTT, HOMA-IR are useful predictors for development of NODAT.

References:

1. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ: Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003;3:178-85.

2. Levy JC, Matthews DR, Hermans MP. Correct Homeostatic Model Assessment (HOMA). Evaluation uses the computer program. Diabetes Care. 1998;21:2191-2.

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