Diagnostic Application of the A1c Assay in Renal Disease

Sharif, Adnan; Baboolal, Keshwar

doi:10.1681/asn.2010010031

Cited by 71 publications

(67 citation statements)

References 17 publications

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“…Future areas of investigation include clinical validation of NODAT risk score engines, validating interventions for primary prevention of NODAT, developing immunosuppressive regimens with minimal diabetogenic effects, and prospectively determining glycemic control on graft survival and cardiovascular outcomes. [15][16][17][18][19][20] Our study showed significant reductions in glycated hemoglobin and fasting plasma glucose values after 12 weeks of additional sitagliptin therapy that were comparable to those with insulin glargine. While sitagliptin addition resulted in a small weight loss (0.4 kg), insulin glargine addition resulted in a weight gain (0.8 kg).…”

Section: Discussionsupporting

confidence: 54%

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Sitagliptin Might Be a Favorable Antiobesity Drug For New Onset Diabetes After a Renal Transplant

Soliman

Fathy²,

Khashab³

et al. 2013

Exp Clin Transplant

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Objectives: The aim of this study was to evaluate the effectiveness of sitagliptin, alone or in combination with metformin, in kidney transplant patients with newly diagnosed new-onset diabetes mellitus after transplant who had inadequate glycemic control, compared with a group of patients receiving insulin glargine with special emphasis on weight gain. Materials and Methods: Newly diagnosed renal transplant patients with new-onset diabetes mellitus after a transplant was defined by a blood glucose ≥ 11.1 mmol/L after an oral glucose tolerance test were examined. They were treated with standard immunosuppression composed of triple therapy with tacrolimus or cyclosporine, mycophenolate mofetil or azathioprine, and prednisone. They had stable graft function for more than 6 months after the transplant. Results: Patients with new-onset diabetes mellitus after transplant (n=28) whose glycemia was not controlled adequately with oral hypoglycemic agents (either alone or in combination) received oral sitagliptin 100 mg once daily in addition to existing therapy for 12 weeks. Patients who received insulin glargine as add-on therapy (n=17) served as the control group. Data analyses included glycated hemoglobin, fasting plasma glucose, lipid profile, body weight, and the occurrence of hypoglycemia. We found significant reductions in glycated hemoglobin and fasting plasma glucose values after 12 weeks of additional sitagliptin therapy that were comparable to those with insulin glargine. While the addition of stagliptin resulted in a small weight loss (0.4 kg), the addition of insulin glargine resulted in a weight gain (0.8 kg). The overall incidence of adverse experiences was low and generally mild in both groups. Conclusions: In a group of renal transplant recipients with new-onset diabetes mellitus after a transplant in whom glycemia was not controlled adequately by oral hypoglycemic agents, the addition of sitagliptin helped to achieve glycemic control similar to insulin glargine but with a marginal weight advantage.

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Section: Discussionsupporting

confidence: 54%

“…Moreover, glycosylated hemoglobin in renal transplant recipients may not adequately reflect glycemia. 16 Therefore, it might be argued that NODAT prevalence would have been a better primary outcome measure. Choosing glycosylated hemoglobin as the primary endpoint was therefore our only option, given the current state of research.…”

Section: Discussionmentioning

confidence: 99%

Sitagliptin Might Be a Favorable Antiobesity Drug For New Onset Diabetes After a Renal Transplant

Soliman

Fathy²,

Khashab³

et al. 2013

Exp Clin Transplant

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“…26 Moreover, HbA1c-mortality association was only demonstrated in non-anemic patients. 34 We did not find any association between baseline or final HbA1c levels and survival in our peritoneal dialysis patients (Table 3) either in diabetic and non-diabetic subgroups (data Figure 1. Survival of diabetic peritoneal dialysis patients compared with non-diabetic counterparts, calculated by Kaplan-Meier method (log-rank: p50.001).…”

Section: Parametermentioning

confidence: 59%

The impact of diabetes mellitus on peritoneal dialysis: the Turkey Multicenter Clinic Study

Özener¹,

Arıkan

Karayaylalı³

et al. 2013

Renal Failure

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Purpose: It is well established that diabetic peritoneal dialysis (PD) patients have a higher mortality rate than the other PD population. This study was designed to determine the overall predictors of survival and compared mortality and morbidity between diabetic and non-diabetic Turkish PD patients. Methods: We conducted a multicenter retrospective study with 915 PD patients [217 had diabetes mellitus (DM)]. Serum albumin, PTH, HbA1c, co-morbid diseases, dialysis adequacy (Kt/V), and peritoneal transport characteristics as well as peritonitis episodes and ultrafiltration failure during the follow-up period were recorded. Results: DM patients were older and had more co-morbidities than non-DM patients. Peritonitis rates were higher in DM patients (one episode per 35.9 patient months) compared to non-DM patients (one episode per 41.5 patient months) (p50.001). On Kaplan-Meier analysis, patient survival was significantly lower in DM patients with the 2-, 3-and 5-year patient survival rates of 90.8%, 87.8% and 78.2% in non-diabetics and 80.9%, 70.4% and 61.2% in diabetics, respectively. On Cox regression analysis, DM (HR 1.5, p ¼ 0.022), age (HR 1.03, p50.001), baseline serum albumin (HR 0.39, p50.001), heart failure (HR 0.038, p ¼ 0.038), peripheral artery disease (HR 1.83, p ¼ 0.025) and amputation (HR 4.1, p ¼ 0.009) at baseline were significant predictors of overall mortality. Conclusions: Patient survival is lower in diabetic compared to non-diabetic patients on PD. Peritonitis rates were also higher in diabetic PD patients. DM, older age, albumin level and cardiovascular co-morbidities are predictors of mortality

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“…5,6 Natural History and Incidence of NODAT The first cases of NODAT were described in 1964 after a liver transplant by Thomas Starz, 7 which occurs mainly during the first 6 months post transplantation during treatment with high doses of immunosuppressant. After 6 months, the annual incidence of diabetes is similar to that observed in patients on the waiting list i.e., 6% per year.…”

Section: Definition Of Nodatmentioning

confidence: 99%

“…44 The use of Glycoslated hemoglobin (HbA1c) is not recommended for the screening given the low sensitivity of the test in ESRD patients. 5 Patients should be screened for risk factors before transplantation in order to prospectively tailor their immunosuppression and minimize the risk of NODAT.…”

Section: Management Of Nodat Pre Transplant Evaluationmentioning

confidence: 99%

New-Onset Diabetes after Transplant (NODAT)

Maskey

2015

Kathmandu Univ. Med. J.

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New onset diabetes mellitus after transplantation (NODAT) is a well known complication following solid organ transplantation and has been reported to occur in 4% to 25% of renal transplant recipients, 2.5% to 25% of liver transplant recipients, hepatitis C virus (HCV) infection between 40% and 60% and 2% to 53% of all solid organ transplants. This variation in the reported incidence may be because of lack of a universal agreement on the definition of NODAT, the duration of followup, and the presence of modifiable and non-modifiable risks factors. Moreover, reduced patient survival and accelerated graft loss have been reported with NODAT. In our country also there is increasing in number of kidney transplants patients and along with that there is chance of development of NODA. It is better to detect the NODATS early. So in this article I tried to presents an overview of the literature on the current diagnostic criteria for NODAT and discuss suggested risk factors for the development of NODAT, its potential pathogenic mechanisms, and its impact on post-transplant outcomes after solid organ transplantation.

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Diagnostic Application of the A1c Assay in Renal Disease

Cited by 71 publications

References 17 publications

Sitagliptin Might Be a Favorable Antiobesity Drug For New Onset Diabetes After a Renal Transplant

Sitagliptin Might Be a Favorable Antiobesity Drug For New Onset Diabetes After a Renal Transplant

The impact of diabetes mellitus on peritoneal dialysis: the Turkey Multicenter Clinic Study

New-Onset Diabetes after Transplant (NODAT)

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