title: Asymptomatic cytomegalovirus infection is associated with increased risk of new-onset diabetes mellitus and impaired insulin release after renal transplantation.
abstract: OBJECTIVE
  The human cytomegalovirus (CMV) may increase the risk of diabetes mellitus, but the literature is scarce. The present study was designed to test the hypothesis that asymptomatic CMV infection is associated with increased risk of new-onset diabetes after renal transplantation, and to assess the impact of asymptomatic CMV infection on OGTT-derived estimates of insulin release and insulin action.
  
  
  METHODS
  A total of 160 consecutive non-diabetic renal transplant recipients on cyclosporine (Sandimmun Neoral)-based immunosuppression were closely monitored for CMV infection during the first 3 months after transplantation. All patients underwent a 75-g OGTT at 10 weeks. Excluded from the analyses were 36 patients with symptomatic CMV infection (disease).
  
  
  RESULTS
  The incidence of new-onset diabetes was 6% in a control group of recipients without CMV infection (4/63) and 26% in the group with asymptomatic CMV infection (16/61). Asymptomatic CMV infection was associated with a significantly increased risk of new-onset diabetes (adjusted odds ratio: 4.00; 95% CI: 1.19 to 13.43, p=0.025). The group of patients with CMV infection had a significantly lower median insulin release than controls.
  
  
  CONCLUSIONS
  Our findings support the hypothesis that asymptomatic CMV infection is associated with increased risk of new-onset post-transplant diabetes mellitus, and suggest that impaired insulin release may involve one pathogenetic mechanism.
authors.affiliation: Department of Medicine, Section of Nephrology, Rikshospitalet University Hospital, Oslo, Norway. joran@online.no.
authors.forename: J
authors.initials: J
authors.lastname: Hjelmesaeth
authors.forename: S
authors.initials: S
authors.lastname: Sagedal
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
authors.forename: H
authors.initials: H
authors.lastname: Rollag
authors.forename: T
authors.initials: T
authors.lastname: Egeland
authors.forename: M
authors.initials: M
authors.lastname: Hagen
authors.forename: K P
authors.initials: KP
authors.lastname: Nordal
authors.forename: T
authors.initials: T
authors.lastname: Jenssen
mesh_terms: D000956:Antigens, Viral / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003586:Cytomegalovirus Infections / Q000150:complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007328:Insulin / Q000097:blood; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology
chemical_list: D000956:Antigens, Viral; D001786:Blood Glucose; D007166:Immunosuppressive Agents; D007328:Insulin