title: Risk factors for the development of posttransplantation diabetes mellitus in simultaneous pancreas and kidney recipients.
abstract: We sought to determine the risk factors involved in the development of posttransplantation diabetes mellitus (PTDM) following simultaneous pancreas and kidney transplantation. Correlations were sought between tacrolimus (FK-506) levels/dose 2-hour capillary glucose (CG) and glycosylated hemoglobin (HbA(1c)), cyclosporine (CSA) levels/dose with HbA1c, 2-hour CG with prednisone dose and body mass index (BMI) and PTDM. Four patients (9.3%) developed PTDM. Three treated with FK-506 had altered 2-hour CG at 3 months after transplantation; 1 prescribed CSA displayed diabetes diagnosed after 1 year. There was no statistically significant difference among HbA(1c) values and FK-506 (P =.18) or CSA (P =.81) doses or FK-506 (P =.53) and CSA (P =.54) levels. In contrast, there was a statistically significant relationship between elevated 2-hour CG (> or =200 mg/dL) and daily prednisone dose (9.7 mg vs. 16.2 mg; P =.003). There was no correlation between 2-hour CG and FK-506 dose (P =.084) or FK-506 levels (P =.075). The greater BMI correlated with an increased risk of PTDM (21.25 +/- 3.13 kg/m(2) vs 24.67 +/- 2.38 kg/m(2); P =.034). Two-hour CG may be a useful tool to screen the diabetogenic effects of corticosteroids. A BMI increase should be discouraged due to the risk of PTDM.
authors.affiliation: Nephrology Division, Federal University of São Paulo, Sao Paulo, SP, Brazil. erikabr@uol.com.br
authors.forename: E B
authors.initials: EB
authors.lastname: Rangel
authors.forename: C S
authors.initials: CS
authors.lastname: Melaragno
authors.forename: J R
authors.initials: JR
authors.lastname: de Sá
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez
authors.forename: M M
authors.initials: MM
authors.lastname: Linhares
authors.forename: W
authors.initials: W
authors.lastname: Aguiar
authors.forename: J O M
authors.initials: JO
authors.lastname: Pestana
mesh_terms: D000293:Adolescent; D000328:Adult; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000276:immunology; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents