Journal Article

Incidence, Risk Factors, and Trends for Postheart Transplantation Diabetes Mellitus

Hardaway, Brian, Cook, Curtiss B., Chakkera, Harini A., Saghafian, Soroush, Munshi, Vidit N., Eric Steidley, D.

2020

Overview

This retrospective study analyzed glycemic trends, incidence of post-transplant diabetes mellitus (PTDM) incidence and associated risk factors in a cohort of patients who underwent first-time heart transplantation (HT). Univariate analyses compared patient with and without pretransplant diabetes mellitus (DM). Multivariate regression analyses were conducted to determine association between PTDM and different risk factors. Finally, trends in glucometrics and other outcomes are described across follow-up time points. There were 152 patients who underwent HT between 2010 and 2015, 109 of whom had no pretransplant history of DM. PTDM incidence was 38% by the 1-year follow-up. Pretransplant body mass index (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.23, p = 0.03), insulin use during the final 24 hours of inpatient stay (OR 4.26, 95% CI 1.72 to 10.56, p <0.01), mean inpatient glucose (OR 2.21, 95% CI 1.33 to 3.69, p <0.01), and mean glucose in the final 24 hours before discharge (OR 1.29, 95% CI 1.03 to 1.60, p = 0.03) were associated with increased odds of PTDM at 1 year. In patients on insulin before discharge, blood glucose values were significantly higher compared with those who were not (136 mg/dl vs 114 mg/dl at 1 to 3 months, 112 vs 100 at 4 to 6 months, 109 vs 98 at 8 to 12 months, all p <0.01). This analysis improves understanding of PTDM incidence, glucometric trends, and risk differences by DM status in the HT population. Similar to liver and kidney patients, inpatient glucometrics may be informative of PTDM risk in HT patients. Guidelines for this population should be developed to account for risk heterogeneity and need for differential management.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Biomarkers - blood / Blood glucose / Blood Glucose - metabolism / Body mass index / Body size / Confidence intervals / Diabetes / Diabetes mellitus / Diabetes Mellitus - blood / Diabetes Mellitus - epidemiology / Diabetes Mellitus - etiology / Female / Follow-Up Studies / Glucose / Glycated Hemoglobin A - metabolism / Graft Rejection - blood / Graft Rejection - complications / Heart transplantation / Heart Transplantation - adverse effects / Hemoglobin / Humans / Hyperglycemia / Incidence / Insulin / Insulin - blood / Male / Middle Aged / Patients / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Regression analysis / Retrospective Studies / Risk analysis / Risk Assessment - methods / Risk Factors / Statistical analysis / Transplantation / Transplants & implants / Trends / United States - epidemiology