title: Glucose metabolism after renal transplantation.
abstract: OBJECTIVE
  We determined prevalence, risk factors, phenotype, and pathophysiological mechanism of new-onset diabetes after transplantation (NODAT) to generate strategies for optimal pharmacological management of hyperglycemia in NODAT patients.
  
  
  METHODS
  Retrospective cohort study comparing demographics, laboratory data, and oral glucose tolerance test (OGTT)-derived metabolic parameters from kidney transplant recipients versus subjects not receiving transplants.
  
  
  RESULTS
  Among 1,064 stable kidney transplant recipients (≥ 6 months posttransplantation), 113 (11%) had a history of NODAT and 132 (12%) had pretransplant diabetes. In the remaining patients, randomly assigned OGTTs showed a high prevalence of abnormal glucose metabolism (11% diabetes; 32% impaired fasting glucose, impaired glucose tolerance, or both), predominantly in older patients who received tacrolimus as the primary immunosuppressant. Compared with 1,357 nontransplant subjects, stable kidney transplant recipients had lower basal glucose, higher glycated hemoglobin, lower insulin secretion, and greater insulin sensitivity in each of the three subgroups, defined by OGTT 2-h glucose (<140, 140-199, ≥ 200 mg/dL). These findings were reinforced in linear spline interpolation models of insulin secretion and sensitivity (all P < 0.001) and in another regression model in which the estimated oral glucose insulin sensitivity index was substantially higher (by 79-112 mL/min m(2)) for transplant versus nontransplant subjects despite adjustments for age, sex, and BMI (all P < 0.001).
  
  
  CONCLUSIONS
  Glucose metabolism differs substantially between kidney transplant recipients and nontransplant controls. Because impaired insulin secretion appears to be the predominant pathophysiological feature after renal transplantation, early therapeutic interventions that preserve, maintain, or improve β-cell function are potentially beneficial in this population.
authors: Department of Nephrology, Medical University of Vienna, Vienna, Austria.
authors: Manfred
authors: M
authors: Hecking
authors: Alexander
authors: A
authors: Kainz
authors: Johannes
authors: J
authors: Werzowa
authors: Michael
authors: M
authors: Haidinger
authors: Dominik
authors: D
authors: Döller
authors: Andrea
authors: A
authors: Tura
authors: Angelo
authors: A
authors: Karaboyas
authors: Walter H
authors: WH
authors: Hörl
authors: Michael
authors: M
authors: Wolzt
authors: Adnan
authors: A
authors: Sharif
authors: Michael
authors: M
authors: Roden
authors: Ermanno
authors: E
authors: Moro
authors: Giovanni
authors: G
authors: Pacini
authors: Friedrich K
authors: FK
authors: Port
authors: Marcus D
authors: MD
authors: Säemann
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
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