Fasting Plasma Glucose and Glycosylated Hemoglobin in the Screening for Diabetes Mellitus After Renal Transplantation

Valderhaug, Tone Gretland; Jenssen, Trond; Hartmann, Anders; Midtvedt, Karsten; Holdaas, Hallvard; Reisæter, Anna Varberg; Hjelmesæth, Jøran

doi:10.1097/tp.0b013e3181af1f53

Cited by 117 publications

(104 citation statements)

References 93 publications

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“…It has previously been found that patients with PTDM in general are characterized with a more or less normal FPG with an isolated postprandial hyperglycemia (25). This is in contrast to patients with type 2 diabetes, who tend to have a better correlation between FPG and postprandial hyperglycemia (26).…”

Section: Discussioncontrasting

confidence: 43%

GLP-1 Restores Altered Insulin and Glucagon Secretion in Posttransplantation Diabetes

et al. 2016

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OBJECTIVEDevelopment of posttransplantation diabetes (PTDM) is characterized by reduced insulin secretion and sensitivity. We aimed to investigate whether hyperglucagonemia could play a role in PTDM and to examine the insulinotropic and glucagonostatic effects of the incretin hormone glucagon-like peptide 1 (GLP-1) during fasting and hyperglycemic conditions, respectively. RESEARCH DESIGN AND METHODSRenal transplant recipients with (n = 12) and without (n = 12) PTDM underwent two separate experimental days with 3-h intravenous infusions of GLP-1 (0.8 pmol/kg/min) and saline, respectively. After 1 h of infusion, a 2-h hyperglycemic clamp (fasting plasma glucose + 5 mmol/L) was established. Five grams of arginine was given as an intravenous bolus 10 min before termination of the clamp. RESULTSFasting concentrations of glucagon (P = 0.92) and insulin (P = 0.23) were similar between the groups. In PTDM patients, glucose-induced glucagon suppression was significantly less pronounced (maximal suppression from baseline: 43 6 12 vs. 65 6 12%, P < 0.001), while first-and second-phase insulin secretion were significantly lower. The PTDM group also exhibited a significantly lower insulin response to arginine (P = 0.01) but similar glucagon and proinsulin responses compared with control subjects. In the preclamp phase, GLP-1 lowered fasting plasma glucose to the same extent in both groups but reduced glucagon only in PTDM patients. During hyperglycemic clamp, GLP-1 reduced glucagon concentrations and increased first-and second-phase insulin secretion in both groups. CONCLUSIONSPTDM is characterized by reduced glucose-induced insulin secretion and attenuated glucagon suppression during a hyperglycemic clamp. Similar to the case in type 2 diabetes, GLP-1 infusion seems to improve (insulin) or even normalize (glucagon) these pathophysiological defects.In renal transplant recipients, cardiovascular disease persists as the leading cause of premature death (1). Development of posttransplantation diabetes (PTDM) is associated with further increased cardiovascular risk and mortality (2-4). PTDM is primarily believed to be a variant of type 2 diabetes possibly induced by immunosuppressive therapy (5) and/or viral infections (e.g., cytomegalovirus and hepatitis C) that reduce both insulin secretion and insulin sensitivity (6). Importantly, the risk of PTDM can be significantly reduced by proper dosing of the immunosuppressive

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Section: Discussioncontrasting

confidence: 43%

GLP-1 Restores Altered Insulin and Glucagon Secretion in Posttransplantation Diabetes

et al. 2016

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“…The recommended approach also suggests performing the OGTT in a large number of patients, making it time-consuming and costly in clinical practice. To select patients for a diagnostic OGTT, screening strategies based on FPG or glycated hemoglobin (HbA 1c ) have been proposed for patients who have undergone transplantation (11)(12)(13) and the general population (14); no such approach has been explored in KTx candidates.…”

mentioning

confidence: 99%

Undiagnosed Diabetes in Kidney Transplant Candidates

Valderhaug¹,

Hartmann²,

Hjelmesæth³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…The incidence of NODAT may be increased as a consequence of the combination of multiple risk factors. Valderhang et al have found that the incidence of NODAT was 14% (14). Several authors have shown that the most important risk factors of NODAT are immunosuppressive drugs, but family history, weight, and BMI of the recipient are also essential (3,4,6,15,16).…”

Section: Discussionmentioning

confidence: 99%

Side effects of the calcineurin inhibitor, such as new-onset diabetes after kidney transplantation

Borda¹,

Lengyel²,

Várkonyi³

et al. 2014

Acta Physiologica Hungarica

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New-onset diabetes after transplantation (NODAT) is one of the frequent complications following kidney transplantation. Patients were randomized to receive cyclosporine A-or tacrolimus-based immunosuppression. Fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following three groups based on the results: normal, impaired fasting glucose/impaired glucose tolerance (IFG/IGT), or NODAT. NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (p = 0.0002). Albumin levels were similar, but uric acid level (p = 0.002) and the age of the recipient (p = 0.003) were significantly different comparing the diabetic and the normal groups. Evaluation of tissue samples revealed that acute cellular rejection (ACR) and interstitial fibrosis/tubular atrophy (IF/TA) were significantly different in the NODAT group. The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before the development of any sign of functional impairment.

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Fasting Plasma Glucose and Glycosylated Hemoglobin in the Screening for Diabetes Mellitus After Renal Transplantation

Cited by 117 publications

References 93 publications

GLP-1 Restores Altered Insulin and Glucagon Secretion in Posttransplantation Diabetes

GLP-1 Restores Altered Insulin and Glucagon Secretion in Posttransplantation Diabetes

Undiagnosed Diabetes in Kidney Transplant Candidates

Side effects of the calcineurin inhibitor, such as new-onset diabetes after kidney transplantation

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