TY - JOUR
T1 - Glycemic management and clinical outcomes in underserved minority kidney transplant recipients with type 2 and posttransplantation diabetes
T2 - A single-center retrospective study
AU - Aleksic, Sandra
AU - Eisenberg, Ruth
AU - Tsomos, Effie
AU - Zahedpour Anaraki, Sara
AU - Japp, Emily
AU - Upadhyay, Laxmi
AU - Mowrey, Wenzhu Bi
AU - Akalin, Enver
AU - Zonszein, Joel
N1 - Funding Information:
The research described was supported by NIH/National Center for Advancing Translational Science ( NCATS ) Einstein-Montefiore CTSA Grant Number UL1 TR002556 .
Funding Information:
The authors thank Omar Alani, Research Associate with the Department of Surgical Transplant at Montefiore-Einstein Center for Transplantation, for the assistance with the IRB submission of the study protocol. No potential conflicts of interest relevant to this article were reported by any of the authors. S.A. designed the study, collected data, provided input on the analytical plan, interpreted the findings, contributed to preparing figures and tables, and wrote the manuscript. R.E. proposed the analytical plan, performed the analysis, provided input on interpretation of the findings, prepared figures and tables, and drafted/revised the manuscript. E.T. and S.Z.A. provided input on study design, collected data, and reviewed/edited the manuscript. E.J. and L.U. collected data and reviewed/edited the manuscript. W.B.M. provided input on the analytical plan, data analysis, and interpretation of the findings and reviewed/edited the manuscript. E.A. designed the study, provided input on analytical plan and interpretation of the findings, and reviewed/edited the manuscript. J.Z. designed the study, provided input on analytical plan and interpretation of the findings and drafted/revised the manuscript. All authors have read and agreed with the manuscript as written. S.A. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity and the accuracy of the data analysis. The research described was supported by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number UL1 TR002556. Parts of this study were presented at the 78th Scientific Sessions of the American Diabetes Association, Orlando, FL, June 22-26, 2018, and at the American Transplant Congress, Seattle, WA, June 2?6, 2018.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/7
Y1 - 2020/7
N2 - Aims: Little is known about glycemic management, particularly with novel cardio-nephroprotecive agents, in underserved minority kidney transplant recipients with pre-transplant type 2 (T2DM) and posttransplantation diabetes mellitus (PTDM). We assessed glycemic management and outcomes in this high-risk population. Methods: We reviewed records of patients who received kidney transplants between June 2012 and December 2014 at a single center. Hemoglobin A1c (HbA1c) and prescribed glucose-lowering medications were examined, and mortality was compared between T2DM, PTDM, and no diabetes (NoDM) patients. Results: We followed 302 patient records (41.1% Hispanic, 41.1% non-Hispanic black) for a median (IQR) of 45.5 (37.0, 53.0) months post-transplant. Pre-transplant T2DM was present in 152 (50.3%), while 58 (19.2%) developed PTDM and 92 (30.4%) remained NoDM. At 1-year post-transplant, the average HbA1c was 8.1 ± 1.8% in T2DM and 6.6 ± 1.3% in PTDM. No glucose-lowering agents were prescribed in 3.4% of T2DM and 44.8% of PTDM. When treated, both received mostly insulin and metformin. Diabetes, HbA1c and insulin therapy were not independently associated with risk of mortality. Conclusions: Glycemic management was suboptimal and relied on older medications. Further studies are needed to assess longer-term outcomes of more rigorous glycemic management, and the value of novel cardio-nephroprotective agents in kidney transplant recipients.
AB - Aims: Little is known about glycemic management, particularly with novel cardio-nephroprotecive agents, in underserved minority kidney transplant recipients with pre-transplant type 2 (T2DM) and posttransplantation diabetes mellitus (PTDM). We assessed glycemic management and outcomes in this high-risk population. Methods: We reviewed records of patients who received kidney transplants between June 2012 and December 2014 at a single center. Hemoglobin A1c (HbA1c) and prescribed glucose-lowering medications were examined, and mortality was compared between T2DM, PTDM, and no diabetes (NoDM) patients. Results: We followed 302 patient records (41.1% Hispanic, 41.1% non-Hispanic black) for a median (IQR) of 45.5 (37.0, 53.0) months post-transplant. Pre-transplant T2DM was present in 152 (50.3%), while 58 (19.2%) developed PTDM and 92 (30.4%) remained NoDM. At 1-year post-transplant, the average HbA1c was 8.1 ± 1.8% in T2DM and 6.6 ± 1.3% in PTDM. No glucose-lowering agents were prescribed in 3.4% of T2DM and 44.8% of PTDM. When treated, both received mostly insulin and metformin. Diabetes, HbA1c and insulin therapy were not independently associated with risk of mortality. Conclusions: Glycemic management was suboptimal and relied on older medications. Further studies are needed to assess longer-term outcomes of more rigorous glycemic management, and the value of novel cardio-nephroprotective agents in kidney transplant recipients.
KW - Glycemic management
KW - Kidney transplantation
KW - Minority
KW - Posttransplantation diabetes
KW - Type 2 diabetes
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U2 - 10.1016/j.diabres.2020.108221
DO - 10.1016/j.diabres.2020.108221
M3 - Article
C2 - 32442553
AN - SCOPUS:85085954119
SN - 0168-8227
VL - 165
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
M1 - 108221
ER -
