Predictors of New Onset of Diabetes after Transplantation in Stable Renal Recipients

BACKGROUND: Several groups identified pre-transplant factors which contribute to the development of new onset of diabetes after transplantation (NODAT). AIM: To identify post-transplant risk factors for NODAT. METHODS: 55 stable renal transplant patients were divided into group A of 34 recipients with normoglycemia and group B of 21 recipients with impaired fasting glucose. Markers including insulin, pro-insulin, soluble receptors for advanced glycated end products (sRAGE), adiponectin, malondialdehyde, homeostasis model assessment of insulin resistance (HOMA-IR), and beta-cell function were calculated at the outset and correlated, thereafter, with the later development of NODAT after a follow-up duration of 14.98 +/- 3.97 months. RESULTS: 11.8 and 19% of groups A and B respectively developed NODAT. Insulin, sRAGE, HOMA-IR and basal fasting plasma glucose correlated with the development of NODAT in univariate analysis. A baseline insulin level of 54.54 mU/l predicted the development of NODAT with a specificity of 95.45% and was the only significant factor in the multivariate analysis. beta-Cell function was not different among the three groups. CONCLUSIONS: A long prodrome of insulin resistance (IR) exists prior to development of NODAT. 50% of patients with NODAT will remit to a normoglycemic state. IR, rather than beta-cell dysfunction, precedes the development of NODAT. Serum insulin in stable non-diabetic renal transplant patients can be used as a confirmatory test to the development of future NODAT.