New-onset diabetes after kidney transplantation

Comparing risk of new onset diabetes mellitus in chronic kidney disease patients receiving peritoneal dialysis and hemodialysis using propensity score matching

Chronic kidney disease (CKD) patients are at risk for developing new-onset diabetes mellitus (NODM) even after hemodialysis (HD) and peritoneal dialysis (PD) treatment. It is not clear if the incidence for NODM is different in CKD patients receiving HD and PD. This study compared the risk of NODM in PD patients and HD patients.

Methods

All HD and PD patients in Taiwan Renal Registry Database from 1997 to 2005 were included and all patients were followed to December 31, 2008. The risk of NODM was analyzed in PD patients and propensity score matched HD patients using logistic regression for early type NODM (< = 6 months after dialysis) and Cox regression for late type NODM (>6 months after dialysis).

Results

A total of 2548 PD patients and 10192 HD patients who had no diabetes on the initiation of dialysis were analyzed. The incidence for NODM was 3.7 per 100 patient/year for HD and 2.4 for PD patients. HD patients are more at risk for developing early type NODM (p<0.001) with an adjusted odds ratio of 1.41 [95% confidence interval (CI) 1.12–1.78)]. HD patients are more at risk for late type NODM (p<0.001) with an adjusted hazard ratio of 2.01 (95% CI: 1.77–2.29). Patient’s age was negatively associated with risk of early type of NODM (p<0.001) but positively associated with risk of late type NODM (p<0.001).

Conclusions

Chronic kidney disease patients receiving hemodialysis are more at risk for developing new-onset diabetes mellitus compared to those receiving peritoneal dialysis.

Steroid-induced diabetes: is it just unmasking of type 2 diabetes?

Aims. We compared the demographic profile and clinical characteristics of individuals with new onset steroid-induced diabetes (NOSID) to Type 2 diabetes (T2DM) patients with and without steroid treatment. Methods. The demographic profile and clinical characteristics of 60 individuals who developed NOSID were examined and matched to 60 type 2 diabetes patients receiving steroid therapy (T2DM+S) and 360 diabetic patients not on steroids (T2DM) for age, duration of diabetes, HbA1c, gender, and ethnicity. Results. Patients who developed NOSID had less family history of diabetes (P ≤ 0.05) and were less overweight (P ≤ 0.02). NOSID was more commonly treated with insulin. Despite a matching duration of diabetes and glycaemic control, significantly less retinopathy was found in the group of patients with NOSID (P < 0.03). Conclusions. It appears that steroid treatment primarily precipitated diabetes in a group of individuals otherwise less affected by risk factors of diabetes at that point in time, rather than just opportunistically unmasking preexisting diabetes. Furthermore, the absence of retinopathy suggests that patients with NOSID had not been exposed to long periods of hyperglycaemia. However, the impact of the underlying conditions necessitating steroid treatment and concomitant medications such as immunosuppressants on diabetes development remain to be defined.

Influence of lifestyle modification in renal transplant recipients with postprandial hyperglycemia

INTRODUCTION

Lifestyle modification is recommended as first-line therapy to manage new-onset diabetes after transplantation (NODAT) and impaired glucose tolerance (IGT). No data currently demonstrate the efficacy of this approach specifically for transplant recipients. This study aimed to assess the benefit of intensive lifestyle modification in this high-risk group and to contrast this with the natural evolution of glucose metabolism after transplantation.

METHODS

Baseline oral glucose tolerance test (OGTT) stratified 115 patients into two groups. Group 1 had glucose intolerance, IGT (n=28) and NODAT (n=8), and received intensive lifestyle modification (dietician referral, exercise program, weight loss advice). Group 2 had normal glucose tolerance (n=79) and received lifestyle modification leaflets. Both groups had follow-up OGTT after 6 months to assess change in glycemic status.

RESULTS

Excluding all patients who received steroid weaning or withdrawal as part of their management, 111 patients were included in the analysis. Lifestyle modification in group 1 resulted in 15% improvement in 2-hr postprandial glucose versus 12% deterioration in group 2. In group 1, 44% (n=11) of IGT patients developed normal glucose tolerance, whereas only 4% (n=1) developed NODAT. Fifty-eight percent (n=4) of NODAT patients showed improvement (29% to IGT and 29% to normal). Glucose metabolism deteriorated in group 2 with 14% (n=10) developing IGT and 3% (n=2) developing NODAT.

CONCLUSIONS

Glucose metabolism can deteriorate in transplant recipients despite passive lifestyle modification advice. This study shows active lifestyle modification benefits high-risk transplant recipients with glucose intolerance and should be aggressively pursued.