Impaired Glucose Metabolism Predominant After Renal Transplant

Daniel M. Keller, PhD

November 01, 2012

SAN DIEGO, California — Despite decreased insulin resistance, impaired glucose metabolism is a major feature after renal transplantation. Manfred Hecking, MD, from the Medical University of Vienna, Austria, reported results here at Kidney Week 2012: American Society of Nephrology 45th Annual Meeting of an oral glucose tolerance test (OGTT) on 307 transplanted patients, finding that impaired insulin secretion was the predominant pathophysiologic feature.

The study authors noted that treatment of new-onset diabetes after transplantation (NODAT) is essentially the same as for type 2 diabetes, even though the pathophysiology of NODAT is unclear. Therefore, the researchers investigated risk factors and underlying mechanisms for NODAT.

They obtained demographic and laboratory data on 1064 stable patients 6 or more months after renal transplantation, of whom 307 without previously diagnosed type 1 or type 2 diabetes or NODAT were randomly assigned to a 2-hour OGTT. Results were compared with a cross-sectional control group of 1356 nontransplanted participants.

The investigators found that 43% of the OGTT results were abnormal among these stable transplanted patients, with 11% having NODAT and 12% having type 1 or type 2 diabetes. Most of the abnormal OGTT results occurred in older patients who received tacrolimus.

When compared with the nontransplanted patients, the transplanted patients had lower basal glucose levels, higher glycated hemoglobin levels, and worse insulin secretion but superior insulin sensitivity.

Estimated insulin sensitivity was higher among the transplanted patients than in the nontransplanted patients, with an oral glucose sensitivity index 79 to 112 mL/min/m2 higher for the transplanted patients after adjustments for age, sex, and body mass index (all P < .001).

The authors suggested that because the underlying pathophysiologic mechanism of NODAT appears to be a deficit in insulin secretion, therapeutic regimens that preserve beta cell function may benefit patients after renal transplantation.

No information about relevant financial relationships was provided.

Kidney Week 2012: American Society of Nephrology 45th Annual Meeting. Abstract TH-PO1050. Presented November 1, 2012.