The dynamics of glucose metabolism under calcineurin inhibitors in the first year after renal transplantation in nonobese patients.
BACKGROUND
The incidence of glucose metabolism disturbances after transplantation often is based on the use of hypoglycemic agents and not on the results of glucose tolerance tests (GTTs), which may camouflage the real incidence. A lack of information also exists regarding the profile of glucose metabolism during the first year after transplant.


METHODS
Oral GTT along with insulin measurements and drugs pharmacokinetics were prospectively performed at days 30, 60, 180, and 360 after transplant to diagnose disturbances of glucose metabolism after renal transplantation, in nonobese patients receiving either tacrolimus (n=55) or cyclosporine (n=29), along with mycophenolate mofetil and steroids.


RESULTS
The incidence of impaired glucose tolerance or diabetes mellitus reached a peak at 60 days and decreased at 1 year. It could not be adequately diagnosed using fasting plasma glucose in a decreased abnormal (>99 ng/mL) range. In both groups, insulin secretion, evaluated by the Homeostasis Model Assesment (HoMA-beta), decreased (P<0.005) from the condition of normal GTT (101+/-56%) to impaired glucose tolerance (72+/-35%) and diabetes mellitus (54+/-25%). In the cyclosporine group, insulin secretion was normal and stable throughout the study period, but in the tacrolimus group, insulin secretion recovered over time and was inversely correlated with tacrolimus exposure. Insulin resistance (HoMA-IR) did not change.


CONCLUSIONS
This study shows the need to perform an oral GTT at 60 days and at the end of the first year of renal transplantation to adequately diagnose impaired glucose metabolism.
David-Neto
Elias
E
Renal Transplantation Unit, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil. elias.david.neto@attglobal.net
Lemos
Francine C
FC
Fadel
Luciana M
LM
Agena
Fabiana
F
Sato
Melissa Y
MY
Coccuza
Christiano
C
Pereira
Lilian M
LM
de Castro
M Cristina R
MC
Lando
Valeria S
VS
Nahas
William C
WC
Ianhez
Luiz E
LE
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000627:therapeutic use; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D000078790:Insulin Secretion; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced / Q000209:etiology; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
D001786:Blood Glucose; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D007328:Insulin; D013256:Steroids; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus