title: Controlling Diabetes After Liver Transplantation: Room for Improvement.
abstract: BACKGROUND
  Diabetes mellitus is a chronic illness with great impact on long-term outcome after liver transplantation (LT). Despite this, the current level of glycemic control and quality of screening strategies for diabetes-associated conditions that are being provided to liver transplant recipients with diabetes have not yet been assessed.
  
  
  METHODS
  We performed a cross-sectional, multicenter study that included 344 liver transplant recipients and examined the level of glycemic control and its associated factors, as well as the quality of screening strategies for diabetes-associated conditions.
  
  
  RESULTS
  Seventy-five patients (21.8%) suffered from diabetes before transplantation, and 82 (23.8%) developed diabetes mellitus after transplantation. Adequate glycemic control (HbA1c < 7%) was achieved in 66.7% of the patients. Forty-eight percent of patients underwent regular screening for retinopathy, 47.1% for nephropathy, 4.5% for neuropathy, and 5.7% for foot ulcers. Diabetes was associated with higher frequency of cardiovascular disease and dyslipidemia both before and after LT. Multivariate analysis revealed association between poor glycemic control and arterial hypertension, presence of diabetes before transplantation, elevated GGT, and insulin use.
  
  
  CONCLUSIONS
  Glycemic control was inadequate in 33.3% of LT recipients with diabetes, and screening protocols for diabetes-associated conditions did not meet the standards for medical care set by the American Diabetes Association in any of the participating centers. Consequently, this study reveals a clear deficiency in the quality of diabetes care provided to patients after LT and, hence, we predict that future progress in this area will have a significant impact on medium-term to long-term outcome of these patients.
authors.affiliation: 1 Hospital Universitario y Politécnico La Fe, Valencia, Spain.2 Hospitén Clínica Roca, Las Palmas, Spain.3 Clínica Universitaria de Navarra, Pamplona, Spain.4 Instituto de Investigación Sanitaria de Navarra (IdiSNA), CIBEREHD, Estella, Spain.5 Hospital Universitario Reina Sofía, CIBEREHD, Córdoba, Spain.6 Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain., Instituto de Investigación Sanitaria de Aragón, Zaraoza, Spain.7 Hospital Universitario y Politécnico La Fe, Universidad de Valencia, CIBEREHD, Valencia, Spain.
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