Diabetogenic effect of tacrolimus in South African patients undergoing kidney transplantation1.
BACKGROUND
Diabetes mellitus (DM) is a complication of tacrolimus therapy. This prospective study evaluated the prevalence of DM in South African black and white patients receiving tacrolimus after kidney transplantation and factors that could identify patients before transplantation who may be at risk of developing DM.


METHODS
Fasting blood samples from 17 patients (11 black, 6 white) were analyzed immediately pretransplantation and at 1 and 3 months posttransplantation for glucose, HbAIC, insulin, C-peptide, free fatty acids, lipids, urea, and creatinine. Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) formulas.


RESULTS
Eight patients (47%) became diabetic (six black, two white), and nine patients (five black, four white) remained nondiabetic. Mean glucose concentrations in the diabetic group were significantly higher at 1 month (P=0.03) and 3 months (P=0.01). Mean insulin level was also significantly raised at 3 months (P=0.01) as was HbAIC (P=0.001). C-peptide concentrations did not change significantly in either group. Significant correlations emerged between fasting glucose concentrations at 3 months posttransplantation and initial HOMA (r=0.486; P=0.048) and initial QUICKI (r=-0.582; P=0.014).


CONCLUSIONS
Occurrence of DM was high and somewhat greater in black patients. IR was the main mechanism involved, together with inadequate beta-cell compensation. IR pretransplantation predicts the subsequent development of DM.
Panz
Vanessa R
VR
Carbohydrate & Lipid Metabolism Research Group, University of the Witwatersrand, Johannesburg, South Africa.
Bonegio
Ramon
R
Raal
Frederick J
FJ
Maher
Heather
H
Hsu
Hon-Chun
HC
Joffe
Barry I
BI
D000328:Adult; D044383:Black People; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006706:Homeostasis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012044:Regression Analysis; D013019:South Africa; D016559:Tacrolimus / Q000009:adverse effects*; D013997:Time Factors; D044465:White People
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; D007328:Insulin; D016559:Tacrolimus