title: Poor Glycemic Control Is Associated With Decreased Survival in Lung Transplant Recipients.
abstract: Diabetes mellitus (DM) is associated with increased mortality after transplantation, but the effect of glycemic control on survival is unknown.We sought to determine the relationship between glycemic control (random blood glucose [RBG], fasting blood glucose [FBG], and glycated hemoglobin [HbA1c]) and survival in all lung transplant (LTx) recipients and those with either persistent or no DM.
  
  
  
  All 210 LTx recipients from August 1, 2010 to November 1, 2013, were included (median observation 3.0 years). All underwent oral glucose tolerance tests pre-LTx and serially post-LTx. All glucose and HbA1c results from LTx until study end were included, and hazard ratios were calculated.
  
  
  
  Of 210 patients, 90 had persistent DM, and 84 had no DM. Overall mortality/repeat LTx was 31%. In the whole cohort, each 1 mM (18 mg/dL) increase in mean FBG and RBG and each 1% increase in mean HbA1c were associated with mortality increases of 18% (95% confidence interval [CI], 5-32%, P = 0.006), 38% (95% CI, 15-65%; P < 0.001), and 46% (95% CI, 15-85%; P = 0.002), respectively. RBG correlated with mortality in the persistent DM and no DM groups, 37% (95% CI, 7-75%; P = 0.012) and 109% (95% CI, 3-323%; P = 0.041) increases/1 mM, respectively).
  
  
  
  Glycemic control strongly correlates with survival after LTx. RBG predicted mortality overall and in patients with and without DM. We propose hyperglycemia be managed promptly after LTx.
authors: 1 Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Australia. 2 Department of Medicine, Monash University, Melbourne, Australia. 3 Lung Transplant Service, The Alfred Hospital, Melbourne, Australia.
authors: Kathryn L
authors: KL
authors: Hackman
authors: Gregory I
authors: GI
authors: Snell
authors: Leon A
authors: LA
authors: Bach
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; C517652:hemoglobin A1c protein, human