title: Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation.
abstract: New-onset diabetes mellitus (NODAT) is a serious complication following renal transplantation. In this cohort study, we studied 118 nondiabetic renal transplant recipients to examine whether indices of insulin resistance and secretion calculated before transplantation and at 3 months post-transplantation are associated with the development of NODAT within 1 year. We also analysed the long-term impact of early diagnosed NODAT. Insulin indices were calculated using homeostasis model assessment (HOMA) and McAuley's Index. NODAT was diagnosed using fasting plasma glucose. Median follow-up was 11 years. The cumulative incidence of NODAT at 1 year was 37%. By logistic regression, recipient age (per year) was the only significant pretransplant predictor of NODAT (OR 1.04, CI 1.009-1.072), while age (OR 1.04, CI 1.005-1.084) and impaired fasting glucose (OR 2.97, CI 1.009-8.733) were significant predictors at 3 months. Pretransplant and 3-month insulin resistance and secretion indices did not predict NODAT. All-cause mortality was significantly higher in recipients developing NODAT within 1 year compared with those remaining nondiabetic (44% vs. 22%, log-rank P = 0.008). By Cox's regression analysis, age (HR 1.075, CI 1.042-1.110), 1-year creatinine (HR 1.007, CI 1.004-1.010) and NODAT within 3 months (HR 2.4, CI 1.2-4.9) were independent predictors of death. In conclusion, NODAT developing early after renal transplantation was associated with poor long-term patient survival. Insulin indices calculated pretransplantation using HOMA and McAuley's Index did not predict NODAT.
authors.affiliation: Nephrology and Transplantation Directorate, University Hospital of Wales, Cardiff CF14 4XW, UK. npramod@doctors.net.uk
authors.forename: Pramod
authors.initials: P
authors.lastname: Nagaraja
authors.forename: Vinod
authors.initials: V
authors.lastname: Ravindran
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
authors.forename: Kesh
authors.initials: K
authors.lastname: Baboolal
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003524:Cyclosporins / Q000008:administration & dosage; D003920:Diabetes Mellitus / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007333:Insulin Resistance; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D014181:Transplantation Immunology; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D003524:Cyclosporins; D007166:Immunosuppressive Agents; D016559:Tacrolimus