title: Clinical evolution of post-transplant diabetes mellitus.
abstract: BACKGROUND
  The long-term clinical evolution of prediabetes and post-transplant diabetes mellitus (PTDM) is unknown.
  
  
  METHODS
  We analysed, in this cohort study, the reversibility, stability and progression of PTDM and prediabetes in 672 patients using repeated oral glucose tolerance tests (OGTTs) for ≤5 years.
  
  
  RESULTS
  Most patients were on tacrolimus, steroids and mycophenolate. About half developed either PTDM or prediabetes. The incidence of PTDM was 32% and bimodal: early PTDM (≤3 months) and late PTDM. Early PTDM reverted in 31%; late PTDM developed in patients with post-transplant prediabetes. The use of OGTTs was necessary to detect around half of PTDM. Pretransplant obesity was a major risk factor for early PTDM, for its persistence and for late PTDM {odds ratio [OR] 1.18 [95% confidence interval (CI) 1.09-1.28]}. At 3 months, higher HbA1c promoted [OR 2.37 (95% CI 1.38-4.06)], while insulin sensitivity protected against [OR 0.64 (95% CI 0.48-0.86)] late PTDM. At 3 months, 28% had prediabetes; of these, 36% remained stable, 43% normalized and 21% developed late PTDM. Pretransplant obesity [OR 1.20 (95% CI 1.04-1.39)] and higher HbA1c [OR 3.80 (95% CI 1.45-9.94)] at 3 months promoted while insulin sensitivity protected against [OR 0.57 (95% CI 0.34-0.95)] evolution from prediabetes to late PTDM. Immunosuppressive levels or acute rejection did not influence PTDM. Most (84%) of the patients with normal tests at 3 months remained stable without evolving into PTDM; 14% developed prediabetes.
  
  
  CONCLUSIONS
  PTDM and prediabetes are very common in renal transplantation. Classic metabolic factors like obesity, prediabetes and insulin resistance promote the evolution of PTDM and prediabetes. Patients with normal glucose metabolism rarely develop PTDM. OGTT is necessary to detect PTDM and prediabetes and thus should be included in clinical practice.
authors.affiliation: Center for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Tenerife, Spain.
authors.forename: Esteban L
authors.initials: EL
authors.lastname: Porrini
authors.affiliation: Nephrology Unit, Fundación Puigvert (FP), Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Díaz
authors.affiliation: Nephrology Unit, Hospital Val d́Hebron, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Moreso
authors.affiliation: Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
authors.forename: Patricia I
authors.initials: PI
authors.lastname: Delgado Mallén
authors.affiliation: Nephrology Unit, Fundación Puigvert (FP), Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Silva Torres
authors.affiliation: Nephrology Unit, Hospital Val d́Hebron, Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Ibernon
authors.affiliation: Nephrology Unit, Hospital Germans Trias y Puyol, Badalona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bayés-Genís
authors.affiliation: Research Unit, Nephrology Unit, Hospital de Cruces, Bilbao, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Benitez-Ruiz
authors.affiliation: Research Unit, Nephrology Unit, Hospital de Cruces, Bilbao, Spain.
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Lampreabe
authors.affiliation: Nephrology Unit, Hospital Germans Trias y Puyol, Badalona, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lauzurrica
authors.affiliation: Nephrology Section, Hospital Nuestra Señora Virgen de las Nieves, Granada, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Osorio
authors.affiliation: Nephrology Section, Hospital Nuestra Señora Virgen de las Nieves, Granada, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Osuna
authors.affiliation: Nephrology Unit, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Domínguez-Rollán
authors.affiliation: Nephrology Unit, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Ruiz
authors.affiliation: Research Unit, Hospital Univesitario de Canarias, Tenerife, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez-Sosa
authors.affiliation: Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: González-Rinne
authors.affiliation: Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Marrero-Miranda
authors.affiliation: Nephrology Unit, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Macía
authors.affiliation: Nephrology Unit, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García
authors.affiliation: Center for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Tenerife, Spain Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
authors.forename: Armando
authors.initials: A
authors.lastname: Torres
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: insulin resistance; post-transplant diabetes; prediabetes