Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus

Harini A. Chakkera, William C. Knowler, Yugandhara Devarapalli, E. Jennifer Weil, Raymond L. Heilman, Amylou Dueck, David C. Mulligan, Kunam S. Reddy, Adyr A. Moss, Kristin L. Mekeel, Marek J. Mazur, Khaled Hamawi, Janna C. Castro, Curtiss B. Cook

Research output: Contribution to journalArticle

58 Scopus citations

Abstract

Background and objectives: Approximately two-thirds of kidney transplant recipients with no previous history of diabetes experience inpatient hyperglycemia immediately after kidney transplant surgery; whether inpatient hyperglycemia predicts future new onset diabetes after transplant (NODAT) is not established. Design, setting, participants, & measurements: A retrospective study was conducted to determine the risk conferred by inpatient hyperglycemia on development of NODAT within 1 year posttransplant. All adult nondiabetic kidney transplant recipients between June 1999 and January 2008 were included. Posttransplant inpatient hyperglycemia was defined as any bedside capillary blood glucose ≥ 200 mg/dl or insulin therapy during hospitalization. NODAT was defined as HbA1C ≥ 6.5%, fasting venous serum glucose ≥ 126 mg/dl, or prescribed diet or medical therapy for diabetes mellitus. Results: The study cohort included 377 patients. NODAT developed in 1 (4%) of the 28 patients without inpatient hyperglycemia, 4 (18%) of the 22 patients with inpatient hyperglycemia but not treated with insulin, and in 98 (30%) of the 327 of the patients who were diagnosed with inpatient hyperglycemia and were treated with insulin. In adjusted analyses, requirement of insulin therapy during hospitalization posttransplant was associated with a 4-fold increase in NODAT (relative risk 4.01; confidence interval, 1.49 to 10.7; P = 0.006). Conclusion: Development of inpatient hyperglycemia after kidney transplantation in nondiabetic patients significantly increased the risk of NODAT. Additionally, we observed a significantly increased risk of cardiovascular events in patients who developed NODAT.

Original languageEnglish (US)
Pages (from-to)1669-1675
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume5
Issue number9
DOIs
StatePublished - Sep 1 2010

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Chakkera, H. A., Knowler, W. C., Devarapalli, Y., Weil, E. J., Heilman, R. L., Dueck, A., Mulligan, D. C., Reddy, K. S., Moss, A. A., Mekeel, K. L., Mazur, M. J., Hamawi, K., Castro, J. C., & Cook, C. B. (2010). Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus. Clinical Journal of the American Society of Nephrology, 5(9), 1669-1675. https://doi.org/10.2215/CJN.09481209