An unexpectedly high prevalence of undiagnosed diabetes in patients awaiting lung transplantation

Hackman, Kathryn L; Snell, Gregory I; Bach, Leon Ashley

doi:10.1016/j.healun.2012.10.010

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…Among patients who did not have pre-Tx DM, higher 1-and 2-h glucose levels on pre-Tx OGTT were predictive of NODAT, but pre-Tx fasting glucose, HbA 1c , insulin levels, and homeostasis model assessment scores were not. We have previously demonstrated that HbA 1c has low sensitivity in the diagnosis of DM in an LTx population (19). Contrary to a large retrospective study (7), we did not find an increased risk of NODAT in men, older recipients (.50 years), or patients with CF.…”

Section: Discussioncontrasting

confidence: 99%

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Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

2014

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OBJECTIVETo determine incidence and prevalence of diabetes mellitus (DM) after lung transplantation (LTx), identify risk factors for persistent DM after LTx, and determine its effect on survival. RESEARCH DESIGN AND METHODSThis was a prospective, longitudinal study comparing DM status before and after LTx using oral glucose tolerance tests (OGTTs). DM prevalence and changes in metabolic control over time were determined. Risk factors for persistent DM and survival differences by DM status were assessed. RESULTSBetween August 2010 and December 2012, 156 patients underwent LTx. DM prevalence after 3, 12, and 24 months was 47%, 44%, and 40%, respectively. A further 20%, 11%, and 7% had impaired glucose tolerance and/or impaired fasting glucose. Incidence of new-onset DM after transplant (NODAT) was 32%, 30%, and 24% after 3, 12, and 24 months. Nonfasting insulin levels and second phase insulin release fell 3 months after transplant (Tx) but returned to baseline by 2 years. The only risk factors for NODAT were 1-and 2-h glucose levels on pre-Tx OGTT (OR 1.73 [95% CI 1.19-2.50], P = 0.004, and 1.84 [1.22-2.77], P = 0.004, respectively). Survival was reduced in patients with DM at study end versus those without (estimated mean 979 days [95% CI 888-1,071] vs. 1,140 days [1,070-1,210], P = 0.023). CONCLUSIONSMost patients had dysglycemia during the first year after LTx, and 32% developed NODAT. Hyperglycemia was caused both by b-cell dysfunction and by insulin resistance. Only pre-Tx OGTT glucose levels predicted persistent NODAT. As DM was common and associated with reduced survival, early detection and management of DM in LTx recipients are warranted.Diabetes mellitus (DM) is a common complication of solid organ transplantation and is associated with increased morbidity and mortality (1). It is especially common after lung transplantation (LTx), firstly because LTx recipients (LTR) require highdose immunosuppression with glucocorticoids in combination with calcineurin inhibitors and secondly because a significant minority of patients have cystic fibrosis (CF), which results both in lung damage necessitating LTx and in destruction of insulin-producing b-cells in the pancreas.

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Section: Discussioncontrasting

confidence: 99%

“…One-year incidence was 56% and 44% in patients with and without CF (5). However, patients were not screened for pre-Tx DM with OGTT, and we have previously demonstrated that history alone underestimates pre-Tx DM prevalence (19).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

2014

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“…This is not surprising as pretransplant DM is often missed (24) and posttransplant DM may also go undetected in the absence of screening programs. Annual ISHLT Registry reports consistently show that recipient DM confers an increased 5-year mortality risk.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Is a Major Risk Factor for Mortality After Lung Transplantation

Hackman

Bailey

Snell

et al. 2014

American Journal of Transplantation

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Survival following lung transplant (LTx) remains significantly lower than after other solid organ transplants. Diabetes mellitus (DM) is a mortality risk factor not comprehensively studied in LTx recipients. Notably, neither the relation of time of DM onset to survival nor the actual causes of DM-associated excess mortality have been described. We determined DM status, DM diagnosis date and all-cause mortality in 386 consecutive adults who underwent LTx at our institution from January 1, 2001 to July 31, 2010. The relationship of DM to survival both as a categorical and time-dependent variable was studied. Fifty-three percent of patients had DM. Overall median survival was 5.2 (95% CI 3.8-6.6) years. At study end, 52% of patients had died, of whom 64% had DM. Estimated median survival was 10 years in patients without DM,) years in patients with DM pre-and post-LTx and 4.3 (3.1-5.5) years in patients with new onset DM. As a timedependent covariate, DM was the strongest risk factor for mortality, hazard ratio 3.96 (2.85-5.51). Bronchiolitis obliterans syndrome was the main cause of death in all patients surviving >90 days, but its incidence was not increased in patients with DM. Further studies are warranted to determine whether improved glycemic control could improve outcomes in LTx recipients.

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“…Diabetes has reached epidemic proportions in the general adult population of China ( 19 ). People with diabetes mellitus and prediabetes who are awaiting LTx remain at risk of mortality following LTx; donors with a history of diabetes mellitus are associated with an increased risk of mortality in the recipient following LTx ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

Adiponectin protects against lung ischemia-reperfusion injury in rats with type 2 diabetes mellitus

Song

Wang

et al. 2018

Mol Med Report

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Adiponectin (APN) has been associated with the pathogenesis of acute brain, liver and heart injury. However, the role of APN in lung ischemia-reperfusion injury (LIRI) in diabetes mellitus remains unclear. To investigate this, the present study evaluated the effects of APN on lung dysfunction and pathological alterations in rats with type 2 diabetes mellitus via lung ischemia/reperfusion (I/R). The lung-protective effects of APN globular domain (gAPN) in rats with type 2 diabetes mellitus were also investigated by measuring the oxygenation index, inflammatory cytokines, lung edema, histopathology, oxidative stress, apoptosis and the protein expression levels of phosphorylated 5′adenosine monophosphate-activated protein kinase (p-AMPK), endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS). The results of the present study demonstrated that the diabetes mellitus rats + I/R (DIR) group exhibited greater concentrations of tumor necrosis factor-α and interleukin-6, and increases in the wet-weight to dry-weight ratio, lung injury score, oxidative stress and cellular apoptosis. These effects were accompanied by lower pulmonary oxygenation compared with the normal rat + I/R (NIR) group (P<0.05). Additionally, all of these alterations were attenuated in the NIR + gAPN and DIR + gAPN groups compared with in the NIR and DIR groups, respectively. In the DIR group, the expression levels of p-AMPK/AMPK and eNOS were significantly downregulated, and the levels of iNOS were upregulated, compared with those of the NIR group. Treatment with APN activated AMPK, increased eNOS expression and attenuated iNOS expression. The results of the present study demonstrated that APN exerted protective effects against LIRI via its anti-inflammatory, antioxidative stress and anti-apoptotic activities. These protective effects of APN were eliminated in rats with type 2 diabetes mellitus, in which LIRI was exacerbated. The present study indicated that APN may be a potential therapeutic agent for LIRI in type 2 diabetes mellitus.

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An unexpectedly high prevalence of undiagnosed diabetes in patients awaiting lung transplantation

Cited by 9 publications

References 23 publications

Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

Prevalence and Predictors of Diabetes After Lung Transplantation: A Prospective, Longitudinal Study

Diabetes Is a Major Risk Factor for Mortality After Lung Transplantation

Adiponectin protects against lung ischemia-reperfusion injury in rats with type 2 diabetes mellitus

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