title: Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus.
abstract: OBJECTIVE
  Approximately two-thirds of kidney transplant recipients with no previous history of diabetes experience inpatient hyperglycemia immediately after kidney transplant surgery; whether inpatient hyperglycemia predicts future new onset diabetes after transplant (NODAT) is not established.
  
  
  METHODS
  A retrospective study was conducted to determine the risk conferred by inpatient hyperglycemia on development of NODAT within 1 year posttransplant. All adult nondiabetic kidney transplant recipients between June 1999 and January 2008 were included. Posttransplant inpatient hyperglycemia was defined as any bedside capillary blood glucose > or = 200 mg/dl or insulin therapy during hospitalization. NODAT was defined as HbA1C > or = 6.5%, fasting venous serum glucose > or = 126 mg/dl, or prescribed diet or medical therapy for diabetes mellitus.
  
  
  RESULTS
  The study cohort included 377 patients. NODAT developed in 1 (4%) of the 28 patients without inpatient hyperglycemia, 4 (18%) of the 22 patients with inpatient hyperglycemia but not treated with insulin, and in 98 (30%) of the 327 of the patients who were diagnosed with inpatient hyperglycemia and were treated with insulin. In adjusted analyses, requirement of insulin therapy during hospitalization posttransplant was associated with a 4-fold increase in NODAT (relative risk 4.01; confidence interval, 1.49 to 10.7; P = 0.006).
  
  
  CONCLUSIONS
  Development of inpatient hyperglycemia after kidney transplantation in nondiabetic patients significantly increased the risk of NODAT. Additionally, we observed a significantly increased risk of cardiovascular events in patients who developed NODAT.
authors.affiliation: Division of Nephrology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA. chakkera.harini@mayo.edu
authors.forename: Harini A
authors.initials: HA
authors.lastname: Chakkera
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.forename: Yugandhara
authors.initials: Y
authors.lastname: Devarapalli
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Weil
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Heilman
authors.forename: Amylou
authors.initials: A
authors.lastname: Dueck
authors.forename: David C
authors.initials: DC
authors.lastname: Mulligan
authors.forename: Kunam S
authors.initials: KS
authors.lastname: Reddy
authors.forename: Adyr A
authors.initials: AA
authors.lastname: Moss
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Mekeel
authors.forename: Marek J
authors.initials: MJ
authors.lastname: Mazur
authors.forename: Khaled
authors.initials: K
authors.lastname: Hamawi
authors.forename: Janna C
authors.initials: JC
authors.lastname: Castro
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
mesh_terms: D000328:Adult; D001130:Arizona; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000209:etiology* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human