Risk factors associated with the onset and progression of posttransplantation diabetes in renal allograft recipients.
OBJECTIVE
The aim of this study was to assess the incidence of posttransplantation diabetes mellitus (PTDM) in renal allograft recipients and to investigate factors contributing to the onset and progression of PTDM and its underlying pathogenic mechanism(s).


METHODS
A total of 77 patients with normal glucose tolerance (NGT) were enrolled in this study. An oral glucose tolerance test was performed 1 week before transplantation and repeated at 1 and 7 years after transplantation.


RESULTS
The overall incidence of PTDM was 39% at 1 year and 35.1% at 7 years posttransplantation. The incidence for each category of PTDM was as follows: persistent PTDM (P-PTDM) (patients who developed diabetes mellitus within 1 year of transplantation and remained diabetic during 7 years), 23.4%; transient PTDM (T-PTDM) (patients who developed diabetes mellitus during the 1st year after transplantation but eventually recovered to have NGT), 15.6%; late PTDM (L-PTDM) (patients who developed diabetes mellitus later than 1 year after transplantation), 11.7%; and non-PTDM during 7 years (N-PTDM7) (patients who did not develop diabetes mellitus during 7 years), 49.3%. Older age (> or = 40 years) at transplantation was a higher risk factor for P-PTDM, whereas a high BMI (> or = 25 kg/m2) and impaired fasting glucose (IFG) at 1 year posttransplantation were higher risk factors for L-PTDM. Impaired insulin secretion rather than insulin resistance was significantly associated with the development of P- and L-PTDM.


CONCLUSIONS
Impaired insulin secretion may be the main mechanism for the development of PTDM. Older age at transplantation seems to be associated with P-PTDM, whereas a high BMI and IFG at 1 year after transplantation were associated with L-PTDM.
Hur
Kyu Yeon
KY
Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong Seodaemun-Gu, Seoul, 120-752, Korea.
Kim
Myoung Soo
MS
Kim
Yu Seun
YS
Kang
Eun Seok
ES
Nam
Jae Hyun
JH
Kim
So Hun
SH
Nam
Chung Mo
CM
Ahn
Chul Woo
CW
Cha
Bong Soo
BS
Kim
Soon Il
SI
Lee
Hyun Chul
HC
D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000235:genetics; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects
D001786:Blood Glucose; D007328:Insulin