Association of body mass index and fasting plasma glucose concentration with post-transplantation diabetes mellitus in Chinese heart transplant recipients

Effect of a mobile APP-based self-care diary combined with nursing for the management of post-heart transplantation diabetes

OBJECTIVES

To retrospectively investigate the effect of a mobile app-based self-care diary, a nursing management method, on post-heart transplantation diabetes.

METHODS

A retrospective analysis was conducted on the general data of 87 patients who underwent heart transplantation in the Cardiac and Thoracic Vascular Surgery Department of Nanjing First Hospital between January 2018 and December 2023. Based on the nursing method, the patients were divided into a control group that received routine nursing measures (n=47 cases) and an observation group that implemented a mobile APP-based self-care diary combined with nursing (n=40 cases). Blood glucose indicators and generic quality of life inventory-74 (GQOLI-74) scores were compared between the two groups three months post-surgery.

RESULTS

Three months after hospital discharge, the observation group showed significantly higher values in the largest amplitude of glycemic excursions (LAGE) and the variation coefficient of fasting plasma glucose (CV-FPG) as well as the general quality of life inventory (GQOLI-74) score compared to the control group (all P<0.01).

CONCLUSIONS

Using a mobile APP-based self-care diary in combination with nursing methods can effectively stabilize blood glucose levels and improve the life quality in post-heart transplantation diabetic patients, demonstrating significant clinical value.

Early post-transplant hyperglycemia and post-transplant diabetes mellitus following heart transplantation

INTRODUCTION

Heart transplantation is an important treatment for end-stage heart failure. Early post-transplant hyperglycemia (EPTH) and post-transplant diabetes mellitus (PTDM) are common following heart transplantation and are associated with increased morbidity and mortality.

AREAS COVERED

This review summarizes the clinical characteristics, diagnosis, and treatment of EPTH and PTDM in cardiac transplant patients, incorporating findings from non-cardiac solid organ transplant studies where relevant due to limited heart-specific research.

EXPERT OPINION

EPTH following heart transplantation is common yet understudied and is associated with the later development of PTDM. PTDM is associated with adverse outcomes including infection, renal dysfunction, microvascular disease, and an increased risk of re-transplantation and mortality. Risk factors for EPTH include the post-operative immunosuppression regimen, recipient and donor age, body mass index, infections, and chronic inflammation. Early insulin treatment is recommended for EPTH, whereas PTDM management is varied and includes lifestyle modification, anti-glycemic agents, and insulin. Given the emerging evidence on the transplant benefits associated with effective glucose control, and the cardioprotective potential of newer anti-glycemic agents, further focus on the management of EPTH and PTDM within heart transplant recipients is imperative.

Weight Gain After Heart Transplantation in Adults: Systematic Review and Meta-Analysis

Gain in weight is common after heart transplantation but the magnitude of usual weight gain and whether this varies by country is unknown. We systematically reviewed all relevant studies to quantify weight change among heart transplant recipients (HTRs) in the years after transplantation and assess variation with geographic location. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica Database databases to September 2020. Eligible studies reported adult HTRs' mean/median weight and/or body mass index (BMI) up to time of transplantation (baseline) and posttransplantation in any language. Weighted mean differences (WMDs) (95% confidence intervals [CIs]) of weight/BMI from baseline to posttransplantation were estimated using a random-effects model. Ten studies met the inclusion criteria. Pooled analysis showed weight gain of 7.1 kg (95% CI, 4.4-9.8 kg) in HTRs 12 months posttransplant, with corresponding BMI increase of 1.69 kg/m2 (95% CI, 0.83-2.55 kg/m2). Greatest weight gain at 12 months posttransplant occurred in US HTRs (WMD weight 10.42 kg, BMI 3.25 kg/m2) and least, in European HTRs (WMD weight 3.10 kg, BMI 0.78 kg/m2). In conclusion, HTRs gain substantial weight in the years after transplantation, but varying widely by geographic location.