New-onset diabetes mellitus after kidney transplantation in Denmark

Background and objectives: This study aimed to investigate the development of new-onset diabetes mellitus (NODM) in a prospective study of 97 nondiabetic uremic patients. Design, setting, participants, & measurements: Included were 57 kidney recipients (Tx group, age 39 13 years) and 40 uremic patients remaining on the waiting list for kidney transplantation (uremic controls, age 47 11 years). All were examined at baseline before possible transplantation and after 12 months. The prevalence of diabetes, prediabetes, insulin sensitivity index (ISI), and insulin secretion index (Isecr) were estimated using an oral glucose tolerance test with measure-ments of plasma glucose and plasma insulin. Results: One year after transplantation NODMwas present in 14 % (8 of 57) compared with 5 % (2 of 40) in the uremic control group (P 0.01). ISI in the Tx group deteriorated from 6.8 3.9 before transplantation to 4.9 2.8 at 12 months after transplantation (P 0.005), and a slight increase in Isecr from 37 19 to 46 22 (P 0.02) was seen. No significant changes occurred in the uremic controls (ISI was 7.9 5 and 8.5 5, and Isecr was 31 17 and 28 15). Using multivariate ordinal logistic regression, pre-Tx ISI and age predicted NODM (odds ratios: 0.82, P 0.01 and 1.06, P 0.02, respectively). Conclusions: One year after kidney transplantation, NODM was present in 14 % of patients. This was mainly caused by an increase in insulin resistance and was observed despite improvement in insulin secretion. Clin J Am Soc Nephrol 5: 709–716, 2010. doi: 10.2215/CJN.0536070