Determinants of Poor Glycemic Control in Patients with Kidney Transplants: A Single-Center Retrospective Cohort Study in Canada

Abstract

Background: Kidney transplant immunosuppressive medications are known to impair glucose metabolism, causing worsened glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and new onset of diabetes after transplant (NODAT). Objectives: To determine the incidence, risk factors, and outcomes of both PrTDM and NODAT patients. Design: This is a single-center retrospective observational cohort study. Setting: The Ottawa Hospital, Ontario, Canada. Participant: A total of 132 adult (>18 years) kidney transplant patients from 2013 to 2015 were retrospectively followed 3 years post-transplant. Measurements: Patient characteristics, transplant information, pre- and post-transplant HbA1C and random glucose, follow-up appointments, complications, and readmissions. Methods: We looked at the prevalence of poor glycemic control (HbA1c >8.5%) in the PrTDM group before and after transplant and compared the prevalence, follow-up appointments, and rate of complications and readmission rates in both the PrTDM and NODAT groups. We determined the risk factors of developing poor glycemic control in PrTDM patients and NODAT. Student t-test was used to compare means, chi-squared test was used to compare percentages, and univariate analysis to determine risk factors was performed by logistical regression. Results: A total of 42 patients (31.8%) had PrTDM and 12 patients (13.3%) developed NODAT. Poor glycemic control (HbA1c >8.5%) was more prevalent in the PrTDM (76.4%) patients compared to those with NODAT (16.7%; P < .01). PrTDM patients were more likely to receive follow-up with an endocrinologist ( P < .01) and diabetes nurse ( P < .01) compared to those with NODAT. There were no differences in the complication and readmission rates for PrTDM and NODAT patients. Receiving a transplant from a deceased donor was associated with having poor glycemic control, odds ratio (OR) = 3.34, confidence interval (CI = 1.08, 10.4), P = .04. Both patient age, OR = 1.07, CI (1.02, 1.3), P < .01, and peritoneal dialysis prior to transplant, OR = 4.57, CI (1.28, 16.3), P = .02, were associated with NODAT. Limitations: Our study was limited by our small sample size. We also could not account for any diabetes screening performed outside of our center or follow-up appointments with family physicians or community endocrinologists. Conclusion: Poor glycemic control is common in the kidney transplant population. Glycemic targets for patients with PrTDM are not being met in our center and our study highlights the gap in the literature focusing on the prevalence and outcomes of poor glycemic control in these patients. Closer follow-up and attention may be needed for those who are at risk for worse glycemic control, which include older patients, those who received a deceased donor kidney, and/or prior peritoneal dialysis.

Creating the nursing care map in the evaluation of kidney transplant candidates: A scoping review and narrative synthesis

“…More specifically, the review also suggests that unhealthy nutrition, which can lead to increased body weight or the development of de novo diabetes mellitus post KT, should be identified and addressed through dietary improvement and weight control plans (Bloom & Crutchlow, 2008 ; Chan Chun Kong et al, 2020 ). The adoption of specialised monitoring strategies aiming to bring about lifestyle changes and reduce risk factors associated with drug use (Buahin & Curran, 2012 ; Corrêa et al, 2013 ; Luchsinger & Zimbrean, 2020 ) or severe pain is also encouraged.…”

“…More specifically, the review also suggests that unhealthy nutrition, which can lead to increased body weight or the development of de novo diabetes mellitus post KT, should be identified and addressed through dietary improvement and weight control plans (Bloom & Crutchlow, 2008;Chan Chun Kong et al, 2020).…”

Work status and work ability of patients receiving kidney replacement therapy: results from a European survey

“…Complications of DM, such as visual impairment, neuropathy and a higher incidence of cardiovascular events, may impede employment. The risk of complications may be different for dialysis patients and KTRs, as the latter may have new-onset DM after KTx, causing fewer complications due to a shorter disease duration and better glycaemic control [ 52 ].…”

Optimising Diabetes Care for Kidney Transplant Recipients

“…However, the emergence of post-transplant diabetes mellitus (PTDM) and exacerbation of diabetes post-transplant, presents significant challenges. After kidney transplantation, hyperglycaemia is common in individuals with pre-existing type 2 diabetes with up to 40% of patients developing de novo PTDM [2]. Identifying diabetes in the context of kidney transplantation is crucial because this group faces an accelerated diabetes complication rate and increased risks of infection, graft failure, cardiovascular complications, and mortality [2][3][4].…”

“…After kidney transplantation, hyperglycaemia is common in individuals with pre-existing type 2 diabetes with up to 40% of patients developing de novo PTDM [2]. Identifying diabetes in the context of kidney transplantation is crucial because this group faces an accelerated diabetes complication rate and increased risks of infection, graft failure, cardiovascular complications, and mortality [2][3][4]. Therefore, active monitoring and proactive management of post-transplant hyperglycaemia are essential to mitigate adverse health outcomes.…”