Post-transplantation diabetes mellitus: evaluation of treatment strategies

• Published in: Clinical transplantation Vol. 29; no. 5; pp. 415 - 424
• Main Authors: Haidinger, M., Antlanger, M., Kopecky, C., Kovarik, J.J., Säemann, M.D., Werzowa, J.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.05.2015
• Subjects: Blood Glucose - analysis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - etiology; dipeptidyl peptidase-4 inhibitor; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Female; Follow-Up Studies; Glomerular Filtration Rate; Glucose Tolerance Test; Graft Rejection - etiology; Graft Rejection - prevention & control; Graft Survival; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Kidney Failure, Chronic - surgery; Kidney Function Tests; kidney transplantation; Kidney Transplantation - adverse effects; Male; Middle Aged; post-transplantation diabetes mellitus; Prognosis; Retrospective Studies; Risk Factors; Thiazolidinediones - therapeutic use; transplant-associated hyperglycemia; dipeptidyl peptidase-4 inhibitor; post-transplantation diabetes mellitus; transplant-associated hyperglycemia; kidney transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12541

Background Post‐transplantation diabetes mellitus (PTDM) is a serious complication after kidney transplantation, but evidence regarding long‐term outcomes of treatment regimens remains scarce. Aim and Methods The aim of this retrospective cohort analysis was to assess the long‐term efficiency and safety of antidiabetic treatments in kidney transplant recipients (KTRs), who were diagnosed with PTDM by an oral glucose tolerance test (OGTT). Results Of 561 KTRs that were screened for PTDM at our outpatient clinic, 71 (13%) had a diabetic OGTT and were included in this study. Mean follow‐up was 34.2 ± 16.1 months. Thirty‐six PTDM patients (51%) received antidiabetic treatment after diagnosis with either a dipeptidyl peptidase‐4 (DPP‐4) inhibitor, a sulfonylurea, pioglitazone, or insulin. These patients had significantly higher fasting glucose and two‐h plasma glucose (2HPG) values at baseline than those who remained without therapy. In contrast to lifestyle modification alone or sulfonylureas, DPP‐4 inhibitors improved glycemic control significantly. Adverse events were generally mild and occurred at similar rates in all groups. Conclusion While sulfonylureas failed to improve glycemic control, DPP‐4 inhibitors appeared effective and safe for the therapy of PTDM after kidney transplantation.