Early Basal Insulin Therapy Decreases New-Onset Diabetes after Renal Transplantation

被引:171
作者
Necking, Manfred [1 ]
Haidinger, Michael [1 ]
Doeller, Dominik [1 ]
Werzowa, Johannes [1 ]
Tura, Andrea [7 ]
Zhang, Jinyao [8 ]
Tekoglu, Hilal [2 ]
Pleiner, Johannes [6 ]
Wrba, Thomas [2 ]
Rasoul-Rockenschaub, Susanne [3 ]
Muehlbacher, Ferdinand [3 ]
Schmaldienst, Sabine [1 ]
Druml, Wilfred [1 ]
Hoerl, Walter H. [1 ]
Krebs, Michael [4 ]
Wolzt, Michael [5 ]
Pacini, Giovanni [7 ]
Port, Friedrich K. [8 ]
Saeemann, Marcus D. [1 ]
机构
[1] Med Univ Vienna, Dept Nephrol, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Informat, A-1090 Vienna, Austria
[3] Med Univ Vienna, Dept Surg, A-1090 Vienna, Austria
[4] Med Univ Vienna, Dept Endocrinol, A-1090 Vienna, Austria
[5] Med Univ Vienna, Dept Clin Pharmacol, A-1090 Vienna, Austria
[6] Med Univ Vienna, Coordinating Ctr Clin Studies, A-1090 Vienna, Austria
[7] CNR, Inst Biomed Engn, Metabol Unit, Padua, Italy
[8] Arbor Res Collaborat Hlth, Ann Arbor, MI USA
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2012年 / 23卷 / 04期
关键词
TERM GLYCEMIC CONTROL; BETA-CELL FUNCTION; RESISTANCE INDEXES; GLUCOSE-METABOLISM; MELLITUS; RECIPIENTS; HYPERGLYCEMIA; CYCLOSPORINE; HEMOGLOBIN; INDUCTION;
D O I
10.1681/ASN.2011080835
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
No effective interventions to reduce risk for new-onset diabetes after transplantation (NODAT), a condition associated with postoperative hyperglycemia and reduced patient and graft survival, have been established. In this 1-year, proof-of-concept clinical trial, we randomly assigned 50 renal transplant recipients to immediate-postoperative isophane insulin for evening blood glucose >= 140 mg/dl (treatment group) or short-acting insulin and/or oral antidiabetic agents for blood glucose >= 180-250 mg/dl (standard-of-care control group). We included only patients without a history of diabetes who received tacrolimus. By the third postoperative evening, all patients in the treatment group had blood glucose >= 140 mg/dl and were subsequently treated with basal insulin; during the first 3 weeks after transplantation, the mean +/- SD daily insulin dosage was 17 +/- 11 IU/d. Among controls, 23 (92%) of 25 had blood glucose >= 200 mg/dl and 18 (72%) of 25 received standard-of-care antihyperglycemic treatment. Asymptomatic hypoglycemia occurred five times in the treatment group and once in the control group. Throughout follow-up, the treatment group had 73% lower odds of NODAT (odds ratio, 0.27) than the control group, and hemoglobin A1c was on average 0.38% lower in the treatment group than the control group. Twelve months after transplantation, all patients in the treatment group were insulin-independent, whereas 7 (28%) of 25 controls required antidiabetic agents. The groups did not differ for insulin sensitivity, but the treatment group showed better beta-cell function throughout the 1-year follow-up. In conclusion, this study suggests regimens that include basal insulin significantly reduce the odds for NODAT after renal transplantation, presumably via insulin-mediated protection of beta cells.
引用
收藏
页码:739 / 749
页数:11
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