High Incidence of Tacrolimus-Associated Posttransplantation Diabetes in the Korean Renal Allograft Recipients According to American Diabetes Association Criteria
- Young Min Cho, MD1,
- Kyong Soo Park, MD, PHD1,
- Hye Seung Jung, MD1,
- Hyun Jung Jeon, MD1,
- Curie Ahn, MD, PHD1,
- Jongwon Ha, MD, PHD2,
- Sang Joon Kim, MD, PHD2,
- Byoung Doo Rhee, MD, PHD3,
- Seong Yeon Kim, MD, PHD1 and
- Hong Kyu Lee, MD, PHD1
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- 3Department of Internal Medicine, Inje University Medical College, Seoul, Korea
Abstract
OBJECTIVE—The incidence of posttransplantation diabetes mellitus (PTDM) has been reported to vary according to different study populations or different definitions. In this study, using American Diabetes Association criteria, the incidence and clinical characteristics of PTDM in Korean renal allograft recipients undergoing tacrolimus-based immunosuppression were examined.
RESEARCH DESIGN AND METHODS—A total of 21 patients taking tacrolimus as primary immunosuppressant were recruited and tested with a serial 75-g oral glucose tolerance test at 0, 1, 3, and 6 months after renal transplantation.
RESULTS—The cumulative incidence of PTDM was 52.4% at 1 month and 57.1% at 3 and 6 months. The baseline characteristics of the PTDM group were old age (especially >40 years), a high BMI, a high fasting glucose level, a high plasma insulin level, and increased insulin resistance. Among these parameters, old age was the only independent risk factor. The insulin secretory capacity in the PTDM group was maximally suppressed 3 months after transplantation. Thereafter, it was gradually restored along with dose reduction of tacrolimus.
CONCLUSIONS—Routine screening for PTDM is necessary in patients over 40 years of age who are undergoing a relatively higher dose tacrolimus therapy during the early course of postrenal transplantation.
- 2-h PG, 2-h plasma glucose during an OGTT
- AUC, area under the curve
- FKBP, FK506-binding protein 12
- FPG, fasting plasma glucose
- HCV, hepatitis C virus
- HOMA-BC, homeostasis model assessment for β-cell function
- HOMA-IR, HOMA for insulin resistance
- IFG, impaired fasting glucose
- IGT, impaired glucose tolerance
- OGTT, oral glucose tolerance test
- PTDM, posttransplantation diabetes mellitus
Footnotes
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Address correspondence and reprint requests to Kyong Soo Park, MD, PHD, Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-Dong Chongno-Gu, Seoul, 110-744, Korea. E-mail: kspark{at}snu.ac.kr.
Received for publication 12 September 2002 and accepted in revised form 10 January 2003.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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