Postprandial Blood Glucose Level in Maintenance Hemodialysis Patients Predicts Post-transplant-Diabetes-mellitus

Abstract

Post-transplant-diabetes-mellitus (PTDM) is a frequent complication after kidney transplantation. One-hundred-and-seven patients with kidney transplantation were screened for the occurrence of PTDM. Of these, full data sets from 49 subjects were available with documented glucose concentrations during maintenance hemodialysis (MHD) and regular clinical follow-up of 7-34 months. For assessment of glucose metabolism the response to a standard meal during MHD was used in normoglycemic patients based on fasting blood glucose. Abnormal postprandial blood glucose concentration was defined as >140 mg/dl 2 h after food intake.Twelve end stage renal disease patients had abnormal postprandial blood glucose on MHD. All 12 subjects but also four MHD patients with normal postprandial and fasting blood glucose values developed PTDM. Multivariate Cox-regression analysis revealed that abnormal postprandial blood glucose is a strong predictor for PTDM (Hazard ratio: 42.3 (IQR: 7.9-227.2); p<0.001). Fasting blood glucose (94 vs. 100 mg/dl) was not different between MHD patients who did (n=16) or did not (n=33) develop PTDM.This study suggests that measurement of postprandial blood glucose during MHD identifies patients who develop PTDM after kidney transplantation. It should be used for screening of patients at risk.

Research update for articles published in EJCI in 2008

“…Post-transplantdiabetes mellitus is a frequent condition after kidney transplantation and associated with poor patient and graft survival. Abnormal postprandial blood glucose level in maintenance haemodialysis patients is a strong predictor for post-transpant diabetes melittus [123] reinforcing our previous conclusion that dysglycaemia occurs frequently in maintenance haemodialysis patients and that routine measurement of blood glucose before and after haemodialysis treatment once monthly should be implemented as a standard of care.…”

“…Among 239 primary normoglycaemic end-stage renal disease patients, 82 patients developed postprandial dysglycaemia and diabetes within 31 months after initiation of haemodialysis therapy. In a subgroup of 36 primary normoglycaemic haemodialysis patients who developed dysglycaemia, event-free survival was low over a period of 5 years [123]. In patients with chronic kidney disease, postprandial hyperglycaemia was found to be an independent risk factor for arteriosclerosis [122].…”

GLP-1 receptor agonist exenatide restores atypical antipsychotic clozapine treatment-associated glucose dysregulation and damage of pancreatic islet beta cells in mice

“…With the administration of a GLP-1 receptor agonist, exenatide, the clozapine-associated enhancement of apoptosis, inhibition of islet cell proliferation and loss of pancreatic beta cell mass were completely restored. Moreover, by the administration of exenatide, the acute increase in serum glucose level was totally reversed in the mice treated with clozapine, and this may exert an additional protective effect on the cardiovascular system in schizophrenic patients, who are at high risk of major cardiovascular events [22] , [23] , [24] . Our results provide preclinical evidence of the pharmaceutical role of GLP-1 receptor agonists in managing glucose dysregulation in schizophrenic patients under long-term atypical antipsychotic treatment.…”

Pulse Pressure and Systolic Blood Pressure are Powerful Independent Predictors of Cardiovascular Disease in Diabetic Adults: Results of an 8.4 years Follow-up of Tehran Lipid and Glucose Study (TLGS)

“…Finally, some misclassifi cation of diabetes status may have occurred due to defi ning new diagnosed diabetes with a single OGTT. In spite of the fact that postprandial hyperglycemia is an early defect in the diabetes ( Haider et al, 2010 ) and OGTT might be suitable for identifi cation of subjects as risk to developing diabetes ( Nawroth et al, 2010 ), the extent of misclassifi cation would have to be extensive to change the results of this study ( Asia Pacifi c Cohort Studies Collaboration, 2007 ). The main strength of our study was, its population based sample consisting of a diabetic population and the continuous monitoring for CVD outcomes.…”