Treatment for Diabetes and Cardiovascular Risk Factors in a Predominantly Minority Urban Cohort of Kidney Transplant Recipients

Abstract

Background: Given the increased incidence of post-transplant diabetes and the high cardiovascular burden in transplant recipients, glycemic control and other cardiovascular risk factors such as blood pressure and cholesterol should be targeted aggressively. We aimed to analyze management of predominantly Hispanic and non-Hispanic black kidney transplant recipients with type 2 diabetes (T2D) and new onset diabetes after transplant (NODAT). Methods: We performed a retrospective chart review of all recipients of kidney transplant from June 01, 2012 until December 31, 2014 in a large university center. Recipients with type 1 diabetes or pancreas transplant were excluded. NODAT was defined by the ADA criteria. Results: The study included 304 individuals. Fifty percent had T2D and another 36% developed NODAT during a follow-up of 37 (22-52) months. Individuals with T2D, compared to NODAT and non-DM, were more frequently treated with statins (76% vs. 65% vs. 39%, respectively, p<0.001). At 6, 12, and 24 months posttransplant individuals with T2D, compared to NODAT, had higher levels of A1c (7.9 ± 1.8 vs. 6.5 ± 1.2%, 8.1 ± 1.8 vs. 6.6 ± 1.3%, 8.6 ± 2.1 vs. 6.6 ± 1.1%, respectively, p<0.0001 for all comparisons) and less frequently reached goal of <7% (33 vs. 80%, 26 vs. 71%, 14 vs. 79%, respectively, p<0.0001 for all comparisons). Most frequent glucose-lowering treatment in T2D was insulin (92%), followed by metformin (20%), DPP-4 inhibitors (19%) and sulfonylurea (11%), while NODAT was treated most frequently with diet only (43%), followed by metformin (20%) and DPP-4 inhibitors (20%). Conclusions: While metabolic control was better in NODAT than T2D, both groups were predominantly treated with older glucose-lowering medications and had a significant number of individuals with suboptimal glucose and lipid management. Earlier and more aggressive treatment with cardio-protective and newer glucose-lowering agents is warranted in this high-risk population. Disclosure E. Tsomos: None. S. Aleksic: None. S. Zahedpour Anaraki: None. E. Japp: None. L. Upadhyay: None. M. Ajaimy: None. J. Zonszein: Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Merck & Co., Inc.. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. E. Akalin: None.