Predictors of new onset of diabetes after transplantation in stable renal recipients.
BACKGROUND
Several groups identified pre-transplant factors which contribute to the development of new onset of diabetes after transplantation (NODAT).


OBJECTIVE
To identify post-transplant risk factors for NODAT.


METHODS
55 stable renal transplant patients were divided into group A of 34 recipients with normoglycemia and group B of 21 recipients with impaired fasting glucose. Markers including insulin, pro-insulin, soluble receptors for advanced glycated end products (sRAGE), adiponectin, malondialdehyde, homeostasis model assessment of insulin resistance (HOMA-IR), and beta-cell function were calculated at the outset and correlated, thereafter, with the later development of NODAT after a follow-up duration of 14.98 +/- 3.97 months.


RESULTS
11.8 and 19% of groups A and B respectively developed NODAT. Insulin, sRAGE, HOMA-IR and basal fasting plasma glucose correlated with the development of NODAT in univariate analysis. A baseline insulin level of 54.54 mU/l predicted the development of NODAT with a specificity of 95.45% and was the only significant factor in the multivariate analysis. beta-Cell function was not different among the three groups.


CONCLUSIONS
A long prodrome of insulin resistance (IR) exists prior to development of NODAT. 50% of patients with NODAT will remit to a normoglycemic state. IR, rather than beta-cell dysfunction, precedes the development of NODAT. Serum insulin in stable non-diabetic renal transplant patients can be used as a confirmatory test to the development of future NODAT.
Shehab-Eldin
Walid
W
Royal University Hospital, Department of Medicine, Division of Nephrology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Shoker
Ahmed
A
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016559:Tacrolimus / Q000276:immunology
D001786:Blood Glucose; D007166:Immunosuppressive Agents; D007328:Insulin; D016559:Tacrolimus