title: Evaluation of Posttransplantation Diabetes Mellitus After Liver Transplantation: Assessment of Insulin Administration as a Risk Factor.
abstract: BACKGROUND
  Impaired glucose regulation posttransplantation can affect allograft survival and may lead to the development of posttransplant diabetes mellitus (PTDM).
  
  
  OBJECTIVE
  The primary purpose of this study is to assess the difference in insulin burden between liver transplant patients who develop PTDM and patients who do not.
  
  
  METHODS
  This was a single-center, retrospective study. Adult liver transplant recipients transplanted between January 1, 2005, and August 1, 2013, were included. PTDM was defined as: (1) use of an oral antihyperglycemic agent for ≥30 consecutive days after transplant, (2) use of insulin ≥30 consecutive days after transplant, or (3) hemoglobin A1C≥6.5 any time after transplant.
  
  
  RESULTS
  Of the 114 patients included, 48 (42%) developed PTDM. The average 24-hour insulin requirement on the medical floors was 17.2 ± 14.5 units in the PTDM group and 11.3 ± 12.2 units in the PTDM-free group;P= 0.02. The average blood glucose level on the medical floor was 184.7 ± 31.5 mg/dL in the PTDM group and 169.3 ± 31.4 mg/dL in the PTDM-free group;P= 0.013. Multivariate analysis revealed that experiencing rejection was positively associated with the development of PTDM: adjusted odds ratio (AOR) = 3.237; 95% CI = 1.214-8.633. Basiliximab was negatively associated with the development of PTDM: AOR = 0.182; 95% CI = 0.040-0.836.
  
  
  CONCLUSIONS
  Univariate analyses suggest that insulin burden is a positive risk factor for the development of PTDM; this association is lost in multivariate analyses. Rejection was a positive predictor, and use of basiliximab was a negative predictor for the development of PTDM.
authors: Hartford Hospital, Hartford, CT, USA kristin.linder@hhchealth.org.
authors: Kristin E
authors: KE
authors: Linder
authors: University of Connecticut School of Pharmacy, Storrs and Farmington, CT, USA.
authors: William L
authors: WL
authors: Baker
authors: Hartford Hospital, Hartford, CT, USA.
authors: Caroline
authors: C
authors: Rochon
authors: Saint Francis Hospital, Hartford, CT, USA.
authors: Scott T
authors: ST
authors: May
authors: Hartford Hospital, Hartford, CT, USA.
authors: Patricia A
authors: PA
authors: Sheiner
authors: Hartford Hospital, Hartford, CT, USA.
authors: Spencer T
authors: ST
authors: Martin
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diabetes mellitus; hyperglycemia; immunosuppression; liver transplantation; new-onset diabetes after transplant; posttransplant diabetes mellitus