Endocrinol Metab.  2020 Dec;35(4):820-829. 10.3803/EnM.2020.743.

Insulin Secretion and Insulin Resistance Trajectories over 1 Year after Kidney Transplantation: A Multicenter Prospective Cohort Study

• Bang JB
• Oh CK
• Kim YS
• Kim SH
• Yu HC
• Kim CD
• Ju MK
• So BJ
• Lee SH
• Han SY
• Jung CW
• Kim JK
• Lee SH
• Jeon JY

• KMID: 2511009
• DOI: http://doi.org/10.3803/EnM.2020.743

Abstract

Background
We investigated the changing patterns of insulin secretion and resistance and risk factors contributing to the development of post-transplant diabetes mellitus (PTDM) in kidney recipients under tacrolimus-based immunosuppression regimen during 1 year after transplantation.
Methods
This was a multicenter prospective cohort study. Of the 168 subjects enrolled in this study, we analyzed a total 87 kidney transplant recipients without diabetes which was assessed by oral glucose tolerance test before transplantation. We evaluated the incidence of PTDM and followed up the index of insulin secretion (insulinogenic index [IGI]) and resistance (homeostatic model assessment for insulin resistance [HOMA-IR]) at 3, 6, 9 months, and 1 year after transplantation by oral glucose tolerance test and diabetes treatment. We also assessed the risk factors for incident PTDM.
Results
PTDM developed in 23 of 87 subjects (26.4%) during 1 year after transplantation. More than half of total PTDM (56.5%) occurred in the first 3 months after transplantation. During 1 year after transplantation, insulin resistance (HOMA-IR) was increased in both PTDM and no PTDM group. In no PTDM group, the increase in insulin secretory function to overcome insulin resistance was also observed. However, PTDM group showed no increase in insulin secretion function (IGI). Old age, status of prediabetes and episode of acute rejection were significantly associated with the development of PTDM.
Conclusion
In tacrolimus-based immunosuppressive drugs regimen, impaired insulin secretory function for reduced insulin sensitivity contributed to the development of PTDM than insulin resistance during 1 year after transplantation.

Keyword

Glucose tolerance test; Diabetes mellitus; Kidney transplantation; Insulin secretion

Figure

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  Fig. 1 Patient selection figure. OGTT, oral glucose tolerance test; PTDM, post-transplant diabetes mellitus.

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  Fig. 2 Incidence of post-transplant diabetes mellitus (PTDM) during 1 year after transplantation. About 87% of PTDM was diagnosed during the first 6 months after transplantation, and no PTDM was discovered at 12 months after transplantation.

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  Fig. 3 Trajectories of insulin resistance and secretion during 1 year after kidney transplantation in both groups. (A) A trend of homeostasis model assessment of insulin resistance (HOMA-IR) levels showed that insulin resistance increased after transplantation in no post-transplant diabetes mellitus (PTDM) and PTDM groups. (B) Insulinogenic index (IGI30) in no PTDM group increased after transplantation; however, IGI30 in PTDM group decreased after transplantation.

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