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Lung transplant increased risk for dysglycemia, new-onset diabetes
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In the first year after undergoing a lung transplant, most patients experience dysglycemia and may also be at significant risk for new-onset diabetes, according to recent findings.
In the prospective, longitudinal study, researchers evaluated 156 patients aged ≥16 years who underwent single, bilateral or heart-lung transplants at the Alfred Hospital in Australia between August 2010 and December 2012. Those patients not being treated for diabetes mellitus underwent screening with a standard 75-g oral glucose tolerance test (OGTT) with insulin levels. The researchers also measured HbA1c in all patients before lung transplant at 3, 12, and 24 months after transplant. The 2006 WHO criteria were used to diagnose diabetes, impaired glucose tolerance and impaired fasting glycemia.
The researchers consulted patient medical records for information regarding patient demographics, BMI and prednisone dose at the time of testing. Univariate logistic regression analyses were used to determine risk factors for new-onset diabetes after transplant (NODAT) at 1 year and 2 years after lung transplant and Kaplan-Meier analyses were performed to calculate survival differences by diabetes status.
The researchers determined diabetes prevalence rates at the following time points: 3 months (47%), 12 months (44%) and 24 months (40%). Further rates of impaired glucose tolerance and/or impaired fasting glycemia at each time point were: 3 months (20%), 12 months (11%) and 24 months (7%). Incidence of NODAT was 32% at 3 months, 30% at 12 months and 24% at 24 months.
At 3 months post-transplant, non-fasting insulin levels and second phase insulin release declined but returned to baseline by the 2-year mark.
The pre-transplant OGTT tests revealed that the only risk factors for NODAT were 1-hour glucose levels (P=.004) and 2-hour glucose levels (P=.004). Patients with diabetes at the conclusion of the study had reduced survival compared with those without diabetes (P=.023).
We suggest that all patients are at significant risk of NODAT, which is concerning, as patients with [diabetes mellitus] had reduced survival,” the researchers wrote. “Further studies are urgently required to determine effective strategies to prevent persistent NODAT. In the meantime, early detection and management of [diabetes mellitus] in [lung transplant recipients] are warranted.”
Disclosure: One researcher received an Alfred Research Trusts Postgraduate Scholarship and a Monash Faculty Postgraduate Scholarship.
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