title: Glycemic Control Reduces Infections in Post-Liver Transplant Patients: Results of a Prospective, Randomized Study.
abstract: Previous studies have shown a relationship between glycemic control and posttransplant morbidity.
  
  
  
  We conducted a prospective randomized controlled trial in postliver transplant patients to evaluate intensive inpatient glycemic control and effects on outcomes to 1 year.
  
  
  
  A total of 164 patients [blood glucose (BG) >180 mg/dL] were randomized into 2 target groups: 82 with a BG of 140 mg/dL and 82 with a BG of 180 mg/dL. Continuous insulin infusions were initiated and then converted to subcutaneous basal bolus insulin therapy by our glucose management service.
  
  
  
  The inpatient mean BG level was significantly different (140 group, 151.4 ± 19.5 mg/dL vs 180 group, 172.6 ± 27.9 mg/dL; P < 0.001). Any infection within 1 year occurred in 35 of the 82 patients (42.7%) in the 140 group and 54 of 82 (65.9%) in the 180 group (P = 0.0046). In a time-to-first infection analysis, being in the 140 group resulted in a hazard ratio of 0.54 (95% confidence interval, 0.35 to 0.83; P = 0.004); the difference between the 2 groups was statistically significant at 1 month (P = 0.008). The number with adjudicated transplant rejection was similar between the 2 groups [17 of 82 (20.7%) and 20 of 82 (24.3%) in the 140 and 180 groups, respectively; P = not significant]. Severe hypoglycemia (BG ≤40 mg/dL) occurred in 3 patients (2 in the 140 group and 1 in the 180 group). However, more patients had moderate hypoglycemia (BG, 41 to 70 mg/dL) in the 140 group [27 of 82 (32.9%) vs 10 of 82 (12.2%) in the 180 group; P = 0.003]. Insulin-related hypoglycemia was not associated with the incidence of severe adverse outcomes.
  
  
  
  Glycemic control of 140 mg/dL safely resulted in a reduced incidence of infection after transplantation compared with 180 mg/dL, but with an increase in moderate hypoglycemia.
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Amisha
authors.initials: A
authors.lastname: Wallia
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schmidt
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Diana Johnson
authors.initials: DJ
authors.lastname: Oakes
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pollack
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Welsh
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Susan
authors.initials: S
authors.lastname: Kling-Colson
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Suruchi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Candice
authors.initials: C
authors.lastname: Fulkerson
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Grazia
authors.initials: G
authors.lastname: Aleppo
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, and.
authors.forename: Neehar
authors.initials: N
authors.lastname: Parikh
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, and.
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, and.
authors.forename: J P
authors.initials: JP
authors.lastname: Norvell
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611.
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin