Early Basal Insulin Therapy Decreases New-Onset Diabetes after Renal Transplantation

Hecking, Manfred; Haidinger, Michael; Döller, Dominik; Werzowa, Johannes; Tura, Andrea; Zhang, Jinyao; Tekoglu, Hilal; Pleiner, Johannes; Wrba, Thomas; Rasoul‐Rockenschaub, Susanne; Mühlbacher, Ferdinand; Schmaldienst, Sabine; Druml, Wilfred; Hörl, Walter H.; Krebs, Michael; Wolzt, Michael; Pacini, Giovanni; Port, Friedrich K.; Säemann, Marcus D.

doi:10.1681/asn.2011080835

Cited by 199 publications

(196 citation statements)

References 45 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: 53%

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: 53%

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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“…Therefore, early application of exogenous insulin may not only control hyperglycemia during the early post-transplant period but also prevent PTDM in long-term survivors. In a prospective randomized control trial assessing the efficacy of basal insulin coverage to prevent PTDM after kidney transplantation, 54 the incidence of diabetes was significantly lower in the basal insulin group than in the control group, which supports the idea that early basal insulin coverage could contribute to β-cell protection after kidney transplantation. Kiddis et al 55 showed that outcomes following renal transplantation could be improved with intensive blood sugar management in patients with established DM.…”

Section: Ptdm and Clinical Outcomesmentioning

confidence: 52%

“…Continuous insulin infusion might improve the impaired neutrophil function observed in DM. 53,54 During the peritransplant period, enormous stress/inflammation or corticosteroids can induce insulin resistance, which leads to hyperglycemia owing to an insufficient insulin secretion to overcome such insulin resistance. CNI also decreases the secretion of insulin by pancreatic β cells.…”

Section: Ptdm and Clinical Outcomesmentioning

confidence: 99%

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Fuji

Rovó

Ohashi

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients frequently develop glucose intolerance and post-transplant diabetes mellitus (PTDM). The clinical importance of PTDM and its detrimental impact on HSCT outcomes are underrecognized. After allo-HSCT, various mechanisms can contribute to the development of PTDM. Here we review information about hyperglycemia and PTDM after allo-HSCT as well as PTDM after solid organ transplantation and describe ways to manage hyperglycemia/PTDM after allogeneic HSCT. Taking into consideration a lack of well-established evidence in the field of allo-HSCT, more studies should be conducted in the future, which will require closer multidisciplinary collaboration between hematologists, endocrinologists and nutritionists.

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“…Future studies are required to determine whether earlier weaning of immunosuppressants or different dosing regimens ameliorate early hyperglycemia and reduced insulin secretion. Early insulin treatment to achieve tight glycemic control has been suggested as a means of reducing persistent NODAT in renal Tx recipients (22,35).…”

Section: Resultsmentioning

confidence: 99%

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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Early Basal Insulin Therapy Decreases New-Onset Diabetes after Renal Transplantation

Cited by 199 publications

References 45 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

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

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

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