Comparison of glycemic control and variability in patients with type 2 and posttransplantation diabetes mellitus.
OBJECTIVE
Posttransplantation diabetes mellitus (PTDM) is a common complication after renal transplantation leading to increased cardiovascular morbidity and mortality. In subjects with type 2 diabetes (T2DM) increased glycemic variability and poor glycemic control have been associated with cardiovascular complications. We therefore aimed at determining glycemic variability and glycemic control in subjects with PTDM in comparison to T2DM subjects.


METHODS
In this observational study we analyzed 10 transplanted subjects without diabetes (Control), 10 transplanted subjects with PTDM, and 8 non-transplanted T2DM subjects using Continuous Glucose Monitoring (CGM). Several indices of glycemic control quality and variability were computed.


RESULTS
Many indices of both glycemic control quality and variability were different between control and PTDM subjects, with worse values in PTDM. The indices of glycemic control, such as glucose mean, GRADE and M-value, were similar in PTDM and T2DM, but some indices of glycemic variability, that is CONGA, lability index and shape index, showed a markedly higher (i.e., worse) value in T2DM than in PTDM (P value range: 0.001-0.035).


CONCLUSIONS
Although PTDM and T2DM subjects showed similar glycemic control quality, glycemic variability was significantly higher in T2DM. These data underscore potential important pathophysiological differences between T2DM and PTDM indicating that increased glycemic variability may not be a key factor for the excess cardiovascular mortality in patients with PTDM.
Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. Electronic address: johannes.werzowa@meduniwien.ac.at.
Johannes
J
Werzowa
CNR Institute of Neuroscience, Padova, Italy.
Giovanni
G
Pacini
Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
Manfred
M
Hecking
Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
Catharina
C
Fidler
Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
Michael
M
Haidinger
Diabetes Outpatient Clinic, Health Center South, Vienna, Austria.
Helmut
H
Brath
Medtronic GmbH, Meerbusch, Germany.
Andreas
A
Thomas
Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
Marcus D
MD
Säemann
CNR Institute of Neuroscience, Padova, Italy.
Andrea
A
Tura
D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology; D004198:Disease Susceptibility; D004351:Drug Resistance; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D010044:Outpatient Clinics, Hospital; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012306:Risk; D012720:Severity of Illness Index
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
Continuous glucose monitoring (CGM); Diabetic complications; Glycemic control; Glycemic variability; Kidney transplantation; Posttransplantation diabetes mellitus (PTDM)