Evaluation of Posttransplantation Diabetes Mellitus After Liver Transplantation: Assessment of Insulin Administration as a Risk Factor. (May 2016)

• Record Type: Journal Article
• Authors: Linder, Kristin E.; Baker, William L.; Rochon, Caroline; May, Scott T.; Sheiner, Patricia A.; Martin, Spencer T.
• Is Part Of: Annals of pharmacotherapy. Volume 50:Number 5(2016:May)
• Page Start: 369
• Page End: 375
• Publication Date: 2016-05
• Subjects: liver transplantation -- diabetes mellitus -- new-onset diabetes after transplant -- posttransplant diabetes mellitus -- hyperglycemia -- immunosuppression; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; 615.5805
• DOI: 10.1177/1060028015627662
• Languages: English
• ISSNs: 1060-0280

Abstract

Background: Impaired glucose regulation posttransplantation can affect allograft survival and may lead to the development of posttransplant diabetes mellitus (PTDM).Objectives: The primary purpose of this study is to assess the difference in insulin burden between liver transplant patients who develop PTDM and patients who do not.Methods: This was a single-center, retrospective study. Adult liver transplant recipients transplanted between January 1, 2005, and August 1, 2013, were included. PTDM was defined as: (1) use of an oral antihyperglycemic agent for ≥30 consecutive days after transplant, (2) use of insulin ≥30 consecutive days after transplant, or (3) hemoglobin A1C ≥6.5 any time after transplant.Results: Of the 114 patients included, 48 (42%) developed PTDM. The average 24-hour insulin requirement on the medical floors was 17.2 ± 14.5 units in the PTDM group and 11.3 ± 12.2 units in the PTDM-free group; P = 0.02. The average blood glucose level on the medical floor was 184.7 ± 31.5 mg/dL in the PTDM group and 169.3 ± 31.4 mg/dL in the PTDM-free group; P = 0.013. Multivariate analysis revealed that experiencing rejection was positively associated with the development of PTDM: adjusted odds ratio (AOR) = 3.237; 95% CI = 1.214-8.633. Basiliximab was negatively associated with the development of PTDM: AOR = 0.182; 95% CI = 0.040-0.836.Conclusion: Univariate analyses suggest that insulin burden is a positive risk factor for the development of PTDM; this association is lost in multivariate analyses. Rejection was a positive predictor, and use of basiliximab was a negative predictor for the development of PTDM.