title: Early basal insulin therapy decreases new-onset diabetes after renal transplantation.
abstract: No effective interventions to reduce risk for new-onset diabetes after transplantation (NODAT), a condition associated with postoperative hyperglycemia and reduced patient and graft survival, have been established. In this 1-year, proof-of-concept clinical trial, we randomly assigned 50 renal transplant recipients to immediate-postoperative isophane insulin for evening blood glucose ≥140 mg/dl (treatment group) or short-acting insulin and/or oral antidiabetic agents for blood glucose ≥180-250 mg/dl (standard-of-care control group). We included only patients without a history of diabetes who received tacrolimus. By the third postoperative evening, all patients in the treatment group had blood glucose ≥140 mg/dl and were subsequently treated with basal insulin; during the first 3 weeks after transplantation, the mean ± SD daily insulin dosage was 17±11 IU/d. Among controls, 23 (92%) of 25 had blood glucose ≥200 mg/dl and 18 (72%) of 25 received standard-of-care antihyperglycemic treatment. Asymptomatic hypoglycemia occurred five times in the treatment group and once in the control group. Throughout follow-up, the treatment group had 73% lower odds of NODAT (odds ratio, 0.27) than the control group, and hemoglobin A1c was on average 0.38% lower in the treatment group than the control group. Twelve months after transplantation, all patients in the treatment group were insulin-independent, whereas 7 (28%) of 25 controls required antidiabetic agents. The groups did not differ for insulin sensitivity, but the treatment group showed better β-cell function throughout the 1-year follow-up. In conclusion, this study suggests regimens that include basal insulin significantly reduce the odds for NODAT after renal transplantation, presumably via insulin-mediated protection of β cells.
authors.affiliation: Department of Nephrology, Medical University of Vienna, Vienna, Austria.
authors.forename: Manfred
authors.initials: M
authors.lastname: Hecking
authors.forename: Michael
authors.initials: M
authors.lastname: Haidinger
authors.forename: Dominik
authors.initials: D
authors.lastname: Döller
authors.forename: Johannes
authors.initials: J
authors.lastname: Werzowa
authors.forename: Andrea
authors.initials: A
authors.lastname: Tura
authors.forename: Jinyao
authors.initials: J
authors.lastname: Zhang
authors.forename: Hilal
authors.initials: H
authors.lastname: Tekoglu
authors.forename: Johannes
authors.initials: J
authors.lastname: Pleiner
authors.forename: Thomas
authors.initials: T
authors.lastname: Wrba
authors.forename: Susanne
authors.initials: S
authors.lastname: Rasoul-Rockenschaub
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmaldienst
authors.forename: Wilfred
authors.initials: W
authors.lastname: Druml
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Michael
authors.initials: M
authors.lastname: Krebs
authors.forename: Michael
authors.initials: M
authors.lastname: Wolzt
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pacini
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Säemann
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin