A systematic review of the literature
- Victor M. Montori, MD, MSC1,
- Ananda Basu, MD1,
- Patricia J. Erwin2,
- Jorge A. Velosa, MD34,
- Sherine E. Gabriel, MD, MSC5 and
- Yogish C. Kudva, MD14
- 1Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota
- 2Medical Library, Mayo Clinic, Rochester, Minnesota
- 3Division of Nephrology and Internal Medicine, Mayo Clinic, Rochester, Minnesota
- 4Transplant Center, Mayo Clinic, Rochester, Minnesota
- 5Section of Clinical Epidemiology, Mayo Clinic, Rochester, Minnesota.
OBJECTIVES— To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management.
RESEARCH DESIGN AND METHODS— We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence.
RESULTS— Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (<10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P = 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted.
CONCLUSIONS— Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs.
Address correspondence and reprint requests to Dr. Yogish C. Kudva, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. E-mail:.
Received for publication 16 July 2001 and accepted in revised form 15 November 2001.
J.A.V. has received funds from Roche and Wyeth Pharmaceuticals.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE