Endocrine Abstracts

Background: The identification of patients with NODAT in renal transplantation is essential to establish adequate treatment and to reduce cardiovascular risk and graft failure. With this study we intended to evaluate the frequency of NODAT and to characterize patients with NODAT in renal transplantation.

Methods: All patients submitted to renal transplantation at Centro Hospitalar do Porto between 01/01/2009 and 12/31/2013 were retrospectively evaluated. Patients with a history of DM, transplantation of more than one organ, younger than 18 years at transplantation, and patients with less than 6 months of follow-up were excluded. DM and intermediate hyperglycemia were defined according to WHO criteria. Patients with hyperglycemia in the postoperative period were considered diabetic only if they maintained criteria 3 months after transplantation.

Results: Of the 556 patients undergoing renal transplantation, 247 patients were excluded and 309 patients were eligible for the analysis. DM screening was performed on all patients by assaying fasting blood glucose; No patient performed PTGO; 88 patients (28.5%) had no recorded HbA1c. The mean follow-up time was 4.2±1.7 years; 99 patients (32.4%) presented alterations in glucose metabolism: 68 (22%) DM criteria, 17 (5.5%) fasting glucose anomaly and 14 (4.5%) transient postoperative hyperglycemia. The mean time to onset of DM was 8.9±15.3 months, with 73.5% of the diagnoses performed in the first 6 months after transplantation. The diagnosis was established through fasting glycemia in 51 patients (75%), HbA1c in 13 (19%) and typical symptoms in 4 (5.9%). Of the 60 patients currently undergoing follow-up, 15 (25%) were without anti-diabetic drugs, 22 (36.7%) with non-insulin anti-diabetics and 23 (38.3%) with insulin. The mean values of fasting blood glucose and HbA1c are 113±33 mg/dl and 6.8±1.4%, respectively.

Discussion and conclusion: We believe that the prevalence of DM found is underestimated considering the use of fasting glycemia as a preferential screening method, which is not very sensitive to the diagnosis of DM in patients undergoing corticosteroid therapy. PTGO would be a valuable complementary diagnostic test to increase diagnostic sensitivity, especially in patients with fasting blood glucose anomalies or classic risk factors for DM.