Johannes Werzowa1, Giovanni Pacini2, Manfred Hecking3, Catharina Fidler3, Michael Haidinger3, Helmut Brath4, Andreas Thomas5, Marcus D Säemann3, Andrea Tura2. 1. Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. Electronic address: johannes.werzowa@meduniwien.ac.at. 2. CNR Institute of Neuroscience, Padova, Italy. 3. Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. 4. Diabetes Outpatient Clinic, Health Center South, Vienna, Austria. 5. Medtronic GmbH, Meerbusch, Germany.
Abstract
AIM: Posttransplantation diabetes mellitus (PTDM) is a common complication after renal transplantation leading to increased cardiovascular morbidity and mortality. In subjects with type 2 diabetes (T2DM) increased glycemic variability and poor glycemic control have been associated with cardiovascular complications. We therefore aimed at determining glycemic variability and glycemic control in subjects with PTDM in comparison to T2DM subjects. METHODS: In this observational study we analyzed 10 transplanted subjects without diabetes (Control), 10 transplanted subjects with PTDM, and 8 non-transplanted T2DM subjects using Continuous Glucose Monitoring (CGM). Several indices of glycemic control quality and variability were computed. RESULTS: Many indices of both glycemic control quality and variability were different between control and PTDM subjects, with worse values in PTDM. The indices of glycemic control, such as glucose mean, GRADE and M-value, were similar in PTDM and T2DM, but some indices of glycemic variability, that is CONGA, lability index and shape index, showed a markedly higher (i.e., worse) value in T2DM than in PTDM (P value range: 0.001-0.035). CONCLUSIONS: Although PTDM and T2DM subjects showed similar glycemic control quality, glycemic variability was significantly higher in T2DM. These data underscore potential important pathophysiological differences between T2DM and PTDM indicating that increased glycemic variability may not be a key factor for the excess cardiovascular mortality in patients with PTDM.
AIM: Posttransplantation diabetes mellitus (PTDM) is a common complication after renal transplantation leading to increased cardiovascular morbidity and mortality. In subjects with type 2 diabetes (T2DM) increased glycemic variability and poor glycemic control have been associated with cardiovascular complications. We therefore aimed at determining glycemic variability and glycemic control in subjects with PTDM in comparison to T2DM subjects. METHODS: In this observational study we analyzed 10 transplanted subjects without diabetes (Control), 10 transplanted subjects with PTDM, and 8 non-transplanted T2DM subjects using Continuous Glucose Monitoring (CGM). Several indices of glycemic control quality and variability were computed. RESULTS: Many indices of both glycemic control quality and variability were different between control and PTDM subjects, with worse values in PTDM. The indices of glycemic control, such as glucose mean, GRADE and M-value, were similar in PTDM and T2DM, but some indices of glycemic variability, that is CONGA, lability index and shape index, showed a markedly higher (i.e., worse) value in T2DM than in PTDM (P value range: 0.001-0.035). CONCLUSIONS: Although PTDM and T2DM subjects showed similar glycemic control quality, glycemic variability was significantly higher in T2DM. These data underscore potential important pathophysiological differences between T2DM and PTDM indicating that increased glycemic variability may not be a key factor for the excess cardiovascular mortality in patients with PTDM.
Authors: Johannes M Werzowa; Marcus D Säemann; Alexander Mohl; Michael Bergmann; Christopher C Kaltenecker; Wolfgang Brozek; Andreas Thomas; Michael Haidinger; Marlies Antlanger; Johannes J Kovarik; Chantal Kopecky; Peter X K Song; Klemens Budde; Julio Pascual; Manfred Hecking Journal: PLoS One Date: 2018-03-08 Impact factor: 3.240