Some Characteristics of Steroid Diabetes: A Study in Renal-Transplant Recipients Receiving High-Dose Corticosteroid Therapy

Arner, Peter; Gunnarsson, R; Blomdahl, Sven; Groth, Carl‐Gustav

doi:10.2337/diacare.6.1.23

Cited by 136 publications

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“…One example is that the onset of both can be insidious (8); individuals may experience glucose intolerance and remain asymptomatic for years before symptoms manifest clinically (9,10). Furthermore, PTDM is not always permanent and may resolve within weeks or months, sometimes without treatment (11). Although several recent reports on a consensus definition of PTDM have been published (5,8,12,13), there are still few studies about the long-term course of PTDM (14).…”

Section: P Osttransplantation Diabetes Mellitusmentioning

confidence: 99%

“…Many previous studies have reported that body weight is one of the risk factors for the development of PTDM (1,11,(25)(26)(27), whereas some studies have reported that the associations between PTDM and body weight or BMI are weak (5,20). As BMI is included in the equation for the dependent parameter ISI TX , a higher BMI is likely to be related to a greater reduction in insulin sensitivity.…”

Section: Incidences Of Different Categories Of Ptdmmentioning

confidence: 99%

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Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Hur

Kim

et al. 2007

Diabetes Care

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OBJECTIVE -The aim of this study was to assess the incidence of posttransplantation diabetes mellitus (PTDM) in renal allograft recipients and to investigate factors contributing to the onset and progression of PTDM and its underlying pathogenic mechanism(s).RESEARCH DESIGN AND METHODS -A total of 77 patients with normal glucose tolerance (NGT) were enrolled in this study. An oral glucose tolerance test was performed 1 week before transplantation and repeated at 1 and 7 years after transplantation.RESULTS -The overall incidence of PTDM was 39% at 1 year and 35.1% at 7 years posttransplantation. The incidence for each category of PTDM was as follows: persistent PTDM (P-PTDM) (patients who developed diabetes mellitus within 1 year of transplantation and remained diabetic during 7 years), 23.4%; transient PTDM (T-PTDM) (patients who developed diabetes mellitus during the 1st year after transplantation but eventually recovered to have NGT), 15.6%; late PTDM (L-PTDM) (patients who developed diabetes mellitus later than 1 year after transplantation), 11.7%; and non-PTDM during 7 years (N-PTDM 7 ) (patients who did not develop diabetes mellitus during 7 years), 49.3%. Older age (Ն40 years) at transplantation was a higher risk factor for P-PTDM, whereas a high BMI (Ն25 kg/m 2 ) and impaired fasting glucose (IFG) at 1 year posttransplantation were higher risk factors for L-PTDM. Impaired insulin secretion rather than insulin resistance was significantly associated with the development of Pand L-PTDM.CONCLUSIONS -Impaired insulin secretion may be the main mechanism for the development of PTDM. Older age at transplantation seems to be associated with P-PTDM, whereas a high BMI and IFG at 1 year after transplantation were associated with L-PTDM. Diabetes Care 30:609 -615, 2007P osttransplantation diabetes mellitus (PTDM) is a major complication after kidney transplantation and can lead to a wide range of complications including graft loss, increased mortality, increased number of rejections, and increased risk of cardiovascular disease (1-4). A recent meta-analysis of observational studies and randomized, controlled trials showed that the incidence of PTDM during the 1st year after transplantation varied from 2 to 50% (5). There have been several previous reports on PTDM in Korean patients, albeit for a short period of observation. We reported previously that the incidence of PTDM was 23.7% in 114 patients treated with cyclosporine A (CsA) at 9 -12 months after transplantation (6), whereas Cho et al. (7) reported that it was 57.1% in 21 patients treated with tacrolimus at 6 months after transplantation in Korea.PTDM and type 2 diabetes are similar in many ways. One example is that the onset of both can be insidious (8); individuals may experience glucose intolerance and remain asymptomatic for years before symptoms manifest clinically (9,10). Furthermore, PTDM is not always permanent and may resolve within weeks or months, sometimes without treatment (11). Although several recent reports on a consensus definition of PTDM ha...

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Section: P Osttransplantation Diabetes Mellitusmentioning

confidence: 99%

Section: Incidences Of Different Categories Of Ptdmmentioning

confidence: 99%

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Hur

Kim

et al. 2007

Diabetes Care

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“…Glucocorticoids (GC) affect glucose metabolism by increasing hepatic glucose production and by reducing peripheral tissue insulin sensitivity (48 -50). In the pre-CNI era, heavy reliance on GC immunosuppression resulted in high rates of NODM (51)(52)(53). Supraphysiologic GC dosages are still commonly used in early posttransplantation induction regimens but are thereafter typically either withdrawn or tapered into the physiologic range within weeks.…”

Section: Immunosuppression and Tahmentioning

confidence: 99%

Transplant-Associated Hyperglycemia

Crutchlow¹,

Bloom²

2007

Clinical Journal of the American Society of Nephrology

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New-onset diabetes has long been recognized as a common complication of kidney transplantation, promoting cardiovascular disease, death, and graft failure. Studies in recent years have begun to highlight the very high posttransplantation prevalence of the prediabetic states of impaired fasting glucose and impaired glucose tolerance and the significant repercussions of these states on cardiovascular health. Therefore, the overall burden of transplant-associated hyperglycemia (TAH), which encompasses new-onset diabetes and the prediabetic states, is far greater than previously appreciated. The kidney transplant population is predisposed to insulin resistance and to additional insults of hypertension and hyperlipidemia that, together with hyperglycemia, compose the metabolic syndrome and promote atherosclerosis. When recipients with an underlying, frequently nonmodifiable predisposition to glucose dysregulation encounter transplant-specific, often modifiable, diabetogenic exposures, TAH manifests. Aggressive screening will effectively detect TAH, whereas risk factor modification, lifestyle intervention, and, when appropriate, drug therapy may decrease its impact. Topics of future investigation should include the use of emerging diabetes therapies and avenues for the prevention and reversal of TAH.

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“…8 Several risk factors for NOD have been identified: Older age, 3,9,10 black race, 2,3,10 Hispanic ethnicity, 2,10 obesity, 2,6 family history of diabetes, 10 hepatitis C positivity, 2,11 and transplantation of a deceased-donor organ. 3,10 In addition, the use of corticosteroids 12,13 and calcineurin inhibitors (CNI) has been associated with an increased risk for NOD. 2,14 -18 The higher risk for NOD in tacrolimus compared with cyclosporine A (CsA)-treated patients identified in observational studies 2 was recently confirmed in a randomized, controlled trial.…”

mentioning

confidence: 99%

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

Johnston

Rose

Webster

et al. 2008

Journal of the American Society of Nephrology

377

238

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New-onset diabetes (NOD) is associated with transplant failure. A few single-center studies have suggested that sirolimus is associated with NOD, but this is not well established. With the use of data from the United States Renal Data System, this study evaluated the association between sirolimus use at the time of transplantation and NOD among 20,124 adult recipients of a first kidney transplant without diabetes. Compared with patients treated with cyclosporine and either mycophenolate mofetil or azathioprine, sirolimus-treated patients were at increased risk for NOD, whether it was used in combination with cyclosporine (adjusted hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.36 to 1.90), tacrolimus (adjusted HR 1.66; 95% CI 1.42 to 1.93), or an antimetabolite (mycophenolate mofetil or azathioprine; adjusted HR 1.36; 95% CI 1.09 to 1.69). Similar results were obtained in a subgroup analysis that included the 16,861 patients who did not have their immunosuppressive regimen changed throughout the first posttransplantation year. In conclusion, sirolimus is independently associated with NOD. Given the negative impact of NOD on posttransplantation outcomes, these findings should be confirmed in prospective studies or in meta-analyses of existing trials that involved sirolimus.

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Some Characteristics of Steroid Diabetes: A Study in Renal-Transplant Recipients Receiving High-Dose Corticosteroid Therapy

Cited by 136 publications

References 0 publications

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Transplant-Associated Hyperglycemia

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

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