title: Glucose control is associated with patient survival in diabetic patients after renal transplantation.
abstract: BACKGROUND
  The efficacy of tight glycemic control for the prevention of death and renal failure in the general diabetic population is well established. However, in diabetic renal-allograft recipients, the effect of different treatment strategies on outcomes is undetermined.
  
  
  METHODS
  We conducted a cohort study of 798 diabetic, renal-allograft recipients transplanted at the Medical University of Vienna between 1990 and 2004. We studied the influence of glucose parameters and diabetes treatment on mortality and graft loss. Marginal-structural models and multivariable Cox regression analysis were used to control for confounding.
  
  
  RESULTS
  Maximal glucose levels but not HbA1c were independently associated with mortality. Being in the highest quartile of maximal glucose increased the adjusted risk of death by a factor of 2.2 (P value for trend 0.009). Furthermore, in patients receiving insulin, the risk of death was increased 1.7-fold (95% confidence interval 0.9-3.1) compared with diet and 2.0-fold (95% confidence interval 1.1-3.7) compared with oral medication. Maximal glucose, HbA1c, or diabetes treatment did not influence death-censored functional graft survival.
  
  
  CONCLUSIONS
  In conclusion, maximal glucose levels and insulin treatment were independently associated with higher rates of mortality in our cohort of diabetic, renal-allograft recipients. However, graft survival was unaffected.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Wiesbauer
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.forename: Heinz
authors.initials: H
authors.lastname: Regele
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Gerit H
authors.initials: GH
authors.lastname: Schernthaner
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwarz
authors.forename: Alexander
authors.initials: A
authors.lastname: Kainz
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
mesh_terms: D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000601:surgery*; D005060:Europe; D006442:Glycated Hemoglobin / Q000378:metabolism; D006085:Graft Survival / Q000502:physiology; D006706:Homeostasis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin