Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus
Harini A Chakkera, William C Knowler, Yugandhara Devarapalli, E Jennifer Weil, Raymond L Heilman, Amylou Dueck, David C Mulligan, Kunam S Reddy, Adyr A Moss, Kristin L Mekeel, Marek J Mazur, Khaled Hamawi, Janna C Castro, Curtiss B Cook, Harini A Chakkera, William C Knowler, Yugandhara Devarapalli, E Jennifer Weil, Raymond L Heilman, Amylou Dueck, David C Mulligan, Kunam S Reddy, Adyr A Moss, Kristin L Mekeel, Marek J Mazur, Khaled Hamawi, Janna C Castro, Curtiss B Cook
Abstract
Background and objectives: Approximately two-thirds of kidney transplant recipients with no previous history of diabetes experience inpatient hyperglycemia immediately after kidney transplant surgery; whether inpatient hyperglycemia predicts future new onset diabetes after transplant (NODAT) is not established.
Design, setting, participants, & measurements: A retrospective study was conducted to determine the risk conferred by inpatient hyperglycemia on development of NODAT within 1 year posttransplant. All adult nondiabetic kidney transplant recipients between June 1999 and January 2008 were included. Posttransplant inpatient hyperglycemia was defined as any bedside capillary blood glucose > or = 200 mg/dl or insulin therapy during hospitalization. NODAT was defined as HbA1C > or = 6.5%, fasting venous serum glucose > or = 126 mg/dl, or prescribed diet or medical therapy for diabetes mellitus.
Results: The study cohort included 377 patients. NODAT developed in 1 (4%) of the 28 patients without inpatient hyperglycemia, 4 (18%) of the 22 patients with inpatient hyperglycemia but not treated with insulin, and in 98 (30%) of the 327 of the patients who were diagnosed with inpatient hyperglycemia and were treated with insulin. In adjusted analyses, requirement of insulin therapy during hospitalization posttransplant was associated with a 4-fold increase in NODAT (relative risk 4.01; confidence interval, 1.49 to 10.7; P = 0.006).
Conclusion: Development of inpatient hyperglycemia after kidney transplantation in nondiabetic patients significantly increased the risk of NODAT. Additionally, we observed a significantly increased risk of cardiovascular events in patients who developed NODAT.
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Source: PubMed