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

Pathophysiology/Complications

¹Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
²Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
³Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
⁴Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea

Soon Il Kim, MD, PhD, Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-Dong Seodaemun-Gu, Seoul, 120-752, Korea. E-mail: soonkim{at}yumc.yonsei.ac.kr
Address correspondence and reprint requests to Hyun Chul Lee, MD, PhD, Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong Seodaemun-Gu, Seoul, 120-752, Korea. E-mail: endohclee{at}yumc.yonsei.ac.kr

Diabetes Care 2007 Mar; 30(3): 609-615. https://doi.org/10.2337/dc06-1277

Article Figures & Tables

Download figure
Open in new tab
Download powerpoint
Figure 1—
Different courses of glucose metabolism in renal allograft recipients.
Download figure
Open in new tab
Download powerpoint
Figure 2—
Serial changes in insulin secretion and insulin sensitivity. A: Secr_1PH. B: Secr_2PH. C: SecrAUC. D: ISI_TX. E: Δ SecrAUC(SecrAUC [at year 1 or 7] − SecrAUC [before transplantation]. F: Δ ISI_TX (ISI [at year 1 or 7] − ISI [before transplantation]. *P < 0.05 and **P < 0.001, compared with N-PTDM₇ at each time point by the Kruskal-Wallis test. Data are expressed as means ± SE. See equations in text for additional details.

Table 1—

Demographic and clinical characteristics of different courses of PTDM

	P-PTDM	L-PTDM	T-PTDM	N-PTDM₇
n (% female)	18 (61.1)†	9 (28.6)	12 (33.3)	38 (26.3)
Age (years)	45.3 ± 10.1‡	34.7 ± 10.6	31.3 ± 9.7	34.2 ± 9.2
Family history of diabetes*	8 (44.4)	1 (11.1)	3 (25)	8 (21.1)
Duration of dialysis (months)	13.2 ± 16.1	7.6 ± 1	6.4 ± 8.6	17.7 ± 21.2
HCV infection	2 (11.1)	0 (0)	0 (0)	1 (2.6)
Donor type (LURDs)	8 (66.7)	2 (22.2)	6 (50)	8 (21.1)
Calcineurin inhibitor
CsA	11 (61.1)	7 (77.8)	8 (66.7)	32 (84.2)
Tacrolimus	7 (38.9)	2 (22.2)	4 (33.3)	6 (15.8)
MMF	10 (55.6)	5 (55.6)	7 (58.3)	16 (42.1)
Acute rejection	4 (22.2)	1 (11.1)	8 (66.7)	0 (0)
BMI (kg/m²)
Before transplantation	22.8 ± 3.2	22.9 ± 3.7	19.5 ± 2.3	21.0 ± 2.3
1 year after transplantation	24.0 ± 3.3‡	24.0 ± 3.1†	20.0 ± 2.3	21.6 ± 2.7
FPG (mmol/l)
Before transplantation	4.8 ± 0.4	4.4 ± 0.7	4.7 ± 0.4	4.7 ± 0.4
1 year after transplantation	6.5 ± 1.1‡	5.7 ± 0.6†	5.2 ± 0.6	5.3 ± 0.6
Total cholesterol (mmol/l)
Before transplantation	4.4 ± 0.9	4.2 ± 1.0	4.2 ± 0.7	3.9 ± 0.9
1 year after transplantation	6.4 ± 1.0†	6.2 ± 0.8	5.7 ± 1.0	5.6 ± 1.1
Triglycerides (mmol/l)
Before transplantation	2.2 ± 1.2	2.6 ± 1.1	1.9 ± 0.8	1.8 ± 1.1
1 year after transplantation	2.2 ± 0.7	2.8 ± 1.2	2.3 ± 2.7	2.1 ± 0.8

Data are expressed as n (%) or means ± SD.
*
↵* Family history of diabetes in a first-degree relative.
†
↵† P < 0.05,
‡
↵‡ P < 0.001 vs. N-PTDM₇. HCV, hepatitis C virus; LURD, living unrelated donor.

Table 2—

Logistic regression analyses for risk factors associated with the various categories of PTDM compared with N-PTDM₇

Variables	No. of patients	P-PTDM			L-PTDM			T-PTDM
Variables	No. of patients			Crude OR*	Adjusted OR†	Crude OR*	Adjusted OR†	Crude OR*	Adjusted OR†
n		18			9			12
Age (years) at transplantation
<40	51	1.0	1.0	1.0	1.0	1.0	1.0
≥40	26	7.5 (2.1–26.2)	6.9 (1.9–25.7)	1.9 (0.4–9.2)	1.9 (0.4–9.3)	1.3 (0.3–5.7)	1.3 (0.3–6.1)
Sex
Male	50	1.0	1.0	1.0	1.0	1.0	1.0
Female	27	4.4 (1.3–14.5)	3.9 (1.1–14.7)	0.8 (0.1–4.5)	0.8 (0.1–4.5)	1.4 (0.4–5.7)	1.4 (0.4–5.9)
Family history of diabetes‡
No	57	1.0	1.0	1.0	1.0	1.0	1.0
Yes	20	3.0 (0.9–10.1)	3.0 (0.7–12.6)	0.5 (0.1–4.3)	0.4 (0.0–4.0)	1.3 (0.3–5.7)	1.3 (0.3–5.9)
Calcineurin inhibitor
CsA	58	1.0	1.0	1.0	1.00	1.0	1.0
Tacrolimus	19	3.4 (0.9–12.3)	3.9 (0.8–19.1)	1.5 (0.3–9.2)	1.4 (0.2–8.6)	2.7 (0.6–11.8)	2.8 (0.6–13.0)
BMI (kg/m²) at 1 year
<25	63	1.0	1.0	1.0	1.0	1.0	1.0
≥25	14	4.3 (1.0–17.7)	2.1 (0.4–10.8)	6.8 (1.3–36.3)	7.4 (1.2–46.7)	NA	NA
FPG (mmol/l) at 1 year
<5.6	48	1.0	1.0	1.0	1.0	1.0	1.0
≥5.6	29	18.7 (4.5–76.6)	32.1 (4.6–223.2)	6.7 (1.4–32.3)	6.3 (1.3–31.5)	2.7 (0.6–11.8)	2.6 (0.6–11.6)

Data are expressed as OR (95% CI). Three logistic regression analyses included patients with P-PTDM vs. N-PTDM₇ (n = 56), L-PTDM vs. N-PTDM₇ (n = 47), and T-PTDM vs. N-PTDM₇ (n = 50), respectively.
*
↵* Unadjusted, univariate logistic regression analysis,
†
↵† age- and sex-adjusted logistic regression analysis,
‡
↵‡ family history of diabetes in a first-degree relative. NA, not applicable.