Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus.
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.
Chakkera
Harini A
HA
Division of Nephrology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA. chakkera.harini@mayo.edu
Knowler
William C
WC
Devarapalli
Yugandhara
Y
Weil
E Jennifer
EJ
Heilman
Raymond L
RL
Dueck
Amylou
A
Mulligan
David C
DC
Reddy
Kunam S
KS
Moss
Adyr A
AA
Mekeel
Kristin L
KL
Mazur
Marek J
MJ
Hamawi
Khaled
K
Castro
Janna C
JC
Cook
Curtiss B
CB
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
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human