Incidence Of New-onset Diabetes Research Articles

Dual Effect of Rosuvastatin on Glucose Homeostasis Through Improved Insulin Sensitivity and Reduced Insulin Secretion

Statins are beneficial in the treatment of cardiovascular disease (CVD), but these lipid-lowering drugs are associated with increased incidence of new on-set diabetes. The cellular mechanisms behind the development of diabetes by statins are elusive. Here we have treated mice on normal diet (ND) and high fat diet (HFD) with rosuvastatin. Under ND rosuvastatin lowered blood glucose through improved insulin sensitivity and increased glucose uptake in adipose tissue. In vitro rosuvastatin reduced insulin secretion and insulin content in islets. In the beta cell Ca2+ signaling was impaired and the density of granules at the plasma membrane was increased by rosuvastatin treatment. HFD mice developed insulin resistance and increased insulin secretion prior to administration of rosuvastatin. Treatment with rosuvastatin decreased the compensatory insulin secretion and increased glucose uptake. In conclusion, our data shows dual effects on glucose homeostasis by rosuvastatin where insulin sensitivity is improved, but beta cell function is impaired.

Statins Plus Metformin: a Promising Combination for Prevention and Treatment of Atherosclerosis

<p>Statins are the cornerstone for primary and secondary prevention of atherosclerosis. But statin monotherapy in some patients will not be sufficient to achieve an LDL-C target and increase the incidence of new-onset diabetes in a dose dependent manner, especially in women, elderly, presence of family history of type 2 diabetes and Asian ethnicity. Recently metformin, an old and effective antidiabetic medication, has been found to reduce LDL-C levels and has cardiac benefits for patients with T2D. Therefore, statins plus metformin may further reduce LDL-C levels and partly counteract statin-induced diabetes.</p>

Belatacept for the prophylaxis of organ rejection in kidney transplant patients: an evidence-based review of its place in therapy.

BackgroundBelatacept is a novel immunosuppressive therapy designed to improve clinical outcomes associated with kidney transplant recipients while minimizing use of calcineurin inhibitors (CNIs).MethodsWe searched for clinical trials related to administration of belatacept to kidney transplant patients compared to various immunosuppression regimens, as well as for studies that utilized data from belatacept trials to validate new surrogate measures. The purpose of this review is to consolidate the published evidence of belatacept’s effectiveness and safety in renal transplant recipients to better elucidate its place in clinical practice.ResultsAnalysis of the results from the Belatacept Evaluation of Nephroprotection and Effi-cacy as First-Line Immunosuppressive Trial (BENEFIT) study, a de novo trial that compared cyclosporine (CsA)-based therapy to belatacept-based therapy in standard criteria donors, found a significant difference in mean estimated glomerular filtration rate (eGFR) of 13–15 mL/min/1.73 m2 and 23–27 mL/min/1.73 m2 at 1 year and 7 years, respectively. The BENEFIT-EXT study was similarly designed with the exception that it included extended criteria donors. Renal function improved significantly for the more intensive belatacept group in all years of the BENEFIT-EXT study; however, it was not significant in the less intensive group until 5 years after transplant. Belatacept regimens resulted in lower blood pressure, cholesterol levels, and incidence of new-onset diabetes after transplant compared to CsA-based regimens. Results from conversion of CNIs to belatacept therapy, dual therapy of belatacept with sirolimus, and belatacept with corticosteroid avoidance therapy are also included in this article.ConclusionThe evidence reviewed in this article suggests that belatacept is an effective alternative in kidney transplant recipients. Compared to CNI-based therapy, belatacept-based therapy results in superior renal function and similar rates of allograft survival. In terms of safety, belatacept was shown to have lower incidence of hypertension, hyperlipidemia, and diabetes; however, incidence of posttransplantation lymphoproliferative disorder and the cost of belatacept may hinder use of this medication.

CRT-800.05 Comparisons of Pitavastatin and Atorvastatin in Diabetic Patients With Acute Myocardial Infarction undergoing Percutaneous Coronary Intervention: A 3-year Clinical Follow-Up Data by a Propensity Score Matched Analysis

Statin is a well-known agent which has a variety of pleiotropic effect for reducing incidence of major adverse cardiovascular events (MACE) among patients (pts) with acute myocardial infarction (AMI). However, there have been an issue related to higher incidence of new onset diabetes and glucose

Role of dipeptidyl peptidase-4 inhibitors in new-onset diabetes after transplantation

Despite strict pre- and post-transplantation screening, the incidence of new-onset diabetes after transplantation (NODAT) remains as high as 60%. This complication affects the risk of cardiovascular events and patient and graft survival rates. Thus, reducing the impact of NODAT could improve overall transplant success. The pathogenesis of NODAT is multifactorial, and both modifiable and nonmodifiable risk factors have been implicated. Monitoring and controlling the blood glucose profile, implementing multidisciplinary care, performing lifestyle modifications, using a modified immunosuppressive regimen, administering anti-metabolite agents, and taking a conventional antidiabetic approach may diminish the incidence of NODAT. In addition to these preventive strategies, inhibition of dipeptidyl peptidase-4 (DPP4) by the gliptin family of drugs has recently gained considerable interest as therapy for type 2 diabetes mellitus and NODAT. This review focuses on the role of DPP4 inhibitors and discusses recent literature regarding management of NODAT.

Evaluation of Adverse Events Associated with Niacin in Patients Treated in an Outpatient Lipid Clinic

Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: The incidence of serious medication-related adverse events has increased by greater than three-fold over the past 10 years. This is especially of concern in patients being placed on medications for the purpose of reducing overall risk of cardiovascular events. Lipid lowering medications are often an integral part of cardiovascular risk reduction due to the known relationship between cardiovascular risk and atherogenic lipoproteins. Niacin is known to reduce non-HDL and LDL cholesterol levels, and in the absence of high-intensity statin therapy, improve clinical outcomes. However recent literature has called attention to serious adverse events in patients when niacin therapy is added to a statin in the setting of wellcontrolled lipids. Therefore concerns have been raised about whether the adverse effects outweigh the benefits of its use. Objective/Purpose: The purpose of this study is to describe serious and non-serious adverse events associated with the use of niacin in an ambulatory lipid clinic. This study population has uncontrolled lipids and may or may not be on high-intensity statin therapy. In this population not represented in recent literature, it is possible that niacin can be used without serious adverse events in the treatment of patients with lipid disorders. Methods: Data will be obtained through retrospective chart review of patients treated with niacin in an outpatient clinic associated with The Ohio State University Wexner Medical Center. Expected results will include incidence of serious and non-serious adverse events, including incidence of adverse gastrointestinal, musculoskeletal, skin, infection, and bleeding related events, as well as the incidence of new onset diabetes. Results for the secondary objectives will include the proportion of patients treated with niacin who achieve patient-specific LDL and non-HDL cholesterol goals, as well as the incidence of major vascular events reported for those treated with niacin. Results: Data collection is ongoing, projected to include a total of 150 patients. Preliminary data showed niacin discontinuation rates of greater than 50% (27/51), however no serious adverse events were reported. Out of those who discontinued therapy, 63% (17/27), were due to a nonserious adverse event, primarily skin-related. Secondary outcomes show an increase in proportion of patients at LDL goal, 27% (14/51) of patients at LDL goal prior to initiation of therapy versus 41% (21/51) upon discontinuation of therapy or study date completion. No major vascular events were reported. Conclusions: Anticipated study completion date of April 1, 2015.

New Recipes With Known Ingredients: Combined Therapy of Everolimus and Low-dose Tacrolimus in De Novo Renal Allograft Recipients

BackgroundCalcineurin inhibitors (CNIs) are the cornerstones of immunosuppressive management in renal allograft recipients even though their nephrotoxicity may contribute to a reduced long-term graft survival. This has created a great interest in improving immunosuppressive strategies in the early post-transplantation period. Proliferation signal inhibitors (PSIs), such as everolimus, are promising alternatives, although their side effects may have a drawback in de novo renal transplant recipients, for instance, delaying renal function in the presence of renal ischemia/acute tubular necrosis and predisposing to lymphocele development. Study and MethodsA retrospective study was developed to compare the combined therapy of low-dose tacrolimus and everolimus (study group) with mycophenolate mofetil/mycophenolic acid and standard-dose tacrolimus (control group) in the first 3 months post-transplantation. The study's end-points concerned renal graft function, proteinuria, incidence of biopsy-proven acute rejection, surgical complication rates, and incidence of new-onset diabetes after renal transplantation. ResultsThere was no more delayed graft function in the study group and graft function distribution was similar between groups. Median serum creatinine and eGFR were comparable as well as proteinuria levels. Generally, adverse events were rare in both groups and there were no significant statistical differences between them in terms of biopsy-proven acute rejection, surgical complication, and new-onset diabetes after renal transplantation rates. ConclusionDespite the slightly lower tendency for serum creatinine in the study group, renal allograft function wasn't statistically different between groups. Moreover, there weren't more metabolic or surgical complications in the study group. Everolimus may be a choice in tacrolimus-sparing strategies, but a larger study and a longer follow-up are still required.

Laparoscopic distal pancreatectomy: analysis of trends in surgical techniques, patient selection, and outcomes.

This study analyzed the time trends of demographic, operative, and pathologic variables in a consecutive series of patients undergoing laparoscopic distal pancreatectomy (LDP). In addition, we assessed the parameters potentially related to the learning curve, and evaluated the long-term outcomes. LDP performed between 1999 and 2012 (minimum follow-up of 1year) were included in the study. The time trends were studied categorizing the operative sequence in three equal groups, and the parameters related to the learning curve were assessed using local regression techniques. All the analyses were stratified by operation type (associated splenectomy vs. spleen-preserving procedures). The study population consisted of 100 patients. There were 57 LDP with associated splenectomy and 41 spleen-preserving LDP; conversion was necessary in 2 cases. The time trend analysis showed that there was not a tendency toward broadening the indications or selecting more difficult cases. Similarly, the study of learning curve components did not show any significant variation over time. Only 45 splenectomized patients received prophylactic vaccinations, and one unvaccinated patient developed an overwhelming post-splenectomy infection. At a median follow-up of 72.5months, 12 patients developed diabetes mellitus, while 8 patients undergoing spleen-preserving LDP developed gastric and perigastric varices. This analysis did not identify parameters related to the patient selection process and the learning curve in LDP. The incidence of new-onset diabetes was lower than reported in other series. The possibility of serious infections following splenectomy has to be taken into account, such that a strict adherence to vaccine protocols is strongly recommended.

Surgical strategy for insulinoma: Analysis of a single-institution experience with 48 cases

Aim The aim of the present study was to investigate the appropriate surgical policy for different locations of insulinomas. Patients and Methods The medical records of 48 patients with a clinical and pathological diagnosis of insulinoma at West China Hospital from 2007 to 2012 were reviewed. The characteristics of clinical manifestation, the diagnosis and surgical strategy of patients with insulinomas were described. Results A total of 85 per cent of the patients had Whipple's triad, and 81 per cent of the patients had a plasma insulin/glucose value greater than 0.3 after a supervised 24-h fast. Diagnostic sensitivity of transabdominal ultrasonography, computed tomography scan, magnetic resonance imaging, and intraoperative ultrasonography were 31 per cent, 75 per cent, 85 per cent and 100 per cent, respectively. Distal pancreatectomy and enucleation were performed in those patients, and pancreatic fistula rates were 37.5 per cent and 14.3 per cent, respectively (P = 0.115). The mean length of hospital stay, the mean length of hospital stay after surgery and the incidence of new-onset diabetes were similar in the two groups; however, the incidence of new-onset exocrine insufficiency was higher in the distal pancreatectomy group than in the enucleation group. Conclusion Modern imaging has a high sensitivity of localization to avoid blind pancreatic resection. Complete surgical resection is the treatment of choice, and enucleation is as safe as distal pancreatectomy.

PTEN upregulation may explain the development of insulin resistance and type 2 diabetes with high dose statins.

Statins increase the incidence of new onset diabetes. Prolonged statin therapy upregulates PTEN expression. PTEN levels are also elevated in diabetic animals. Activation of protein kinase A by cAMP decreases PTEN expression. We assessed whether prolonged treatment with rosuvastatin (ROS) induces glucose intolerance by upregulating Phosphatase and Tensin Homologue on Chromosome 10 (PTEN) in mice receiving normal (ND) or Western Diet (WD) and whether concomitant treatment with cilostazol (CIL, a phosphodiesterase-3 inhibitor) attenuates the effects. PTEN(loxp/cre) or PTEN(+/-) mice received ND or WD without or with ROS (10 mg/kg/day). Wild-type mice received ND or WD without or with ROS, CIL (10 mg/kg/day), or ROS+CIL for 30 days. Fasting insulin and glucose tolerance test were measured as well as PTEN and P-AKT levels in skeletal muscle. Serum glucose after intraperitoneal injection of glucose was higher in PTEN(loxp/cre) mice receiving WD or ROS and especially WD+ROS. Levels were lower in PTEN(+/-) mice compared to PTEN(loxp/cre) in each treatment group. CIL decreased glucose levels in mice receiving WD, ROS and their combination. Insulin levels were higher in the WD+ROS group. CIL decreased insulin in mice receiving WD+ROS. WD, ROS and especially their combination increased PTEN and decreased P-AKT levels. CIL attenuated the effect of WD, ROS and their combination. Long-term ROS can induce diabetes by upregulating PTEN. CIL attenuates these changes. Partial knockdown of PTEN also ameliorates ROS-induced insulin resistance. Further studies are needed to assess the effects of increasing cAMP levels to prevent the induction of diabetes by statins.

An in-progress, open-label, multi-centre study (SAILOR) evaluating whether a steroid-free immunosuppressive protocol, based on ATG induction and a low tacrolimus dose, reduces the incidence of new onset diabetes after transplantation.

BackgroundCorticosteroids and calcineurin inhibitors (CNIs) are included in renal transplantation immunosuppressive protocols around the world. Well-known side effects are associated with the use of these drugs, including new onset of diabetes after transplantation (NODAT). Long-term patient survival rates are lower among patients with NODAT. The optimal immunosuppressive protocol would therefore include not using corticosteroids and minimization of CNI use.Methods/DesignThis is a prospective, multi-centre, controlled, randomized, parallel group, open-label study involving kidney transplant patients. The study compares a steroid-free immunosuppressive protocol (study arm A), which is based on low-dose tacrolimus and mycophenolate mofetil (MMF) maintenance therapy together with antithymocyte globulin (ATG) induction, with the conventional immunosuppressive protocol (study arm B), being based on low-dose tacrolimus, MMF and steroids together with interleukin-2 receptor (IL2-R) induction. The study is designed to include most normal-risk patients. It will exclude patients seen as at a high risk of rejection. The primary objective of the study is to assess the cumulative incidence of NODAT in the two study arms 12 months after transplantation using the American Diabetes Association type 2 diabetes diagnostic criteria. The composite measure of freedom from acute rejection, graft survival and patient survival will be evaluated. Renal function and chronic changes in the transplanted kidney will be assessed.DiscussionIf this study confirms conceptual expectations, namely decreased incidence of NODAT, the steroid-free study protocol could be used with all patients. The regimen could be especially beneficial for patients at a high risk of diabetes mellitus.Trial registrationTrial registration: EudraCT 2012-000451-13.

TCTAP A-206 Three-year Cumulative Incidence of New-onset Diabetes; Are There Differences Between Atorvastatin and Simvastatin?

Chronic statin administration may be associated with modestly increased risk of new-onset type 2 diabetes mellitus (T2DM). However, there were no data whether there are different influence on the development of diabetes mellitus between atorvastatin and simvastatin. A total of 877 hyperlipidemia

The Influence of Statins on Glucose Tolerance and Incipient Diabetes

The US Food and Drink Administration (FDA) recently published a warning that statin usage may increase the risk for type 2 diabetes. However, the incidence of new-onset diabetes varies substantially among clinical trials investigating the efficacy and safety of statins. Meta-analyses indicate that statin therapy is associated with an increased risk for diabetes of approximately 9 %. The risk for incident diabetes may be associated with higher doses and potencies of statins. Mechanisms explaining the potentially higher incidence of type 2 diabetes with statin therapy have not been fully elucidated, and statins differ considerably in terms of their effect on glucose metabolism and ultimately incident diabetes. It is widely accepted that the cardiovascular benefits associated with statin use greatly outweigh the risks for diabetes. However, the effect of different statins on glycemic parameters may influence the choice of statin in those with risk factors for diabetes. Unlike the other stains, pitavastatin raises adiponectin levels, which in turn lowers insulin resistance and improves insulin secretion. Furthermore, numerous studies have concluded that pitavastatin and pravastatin do not affect glycemic control and may be favorable treatment options in patients with, or at risk for, type 2 diabetes.

Erratum

International Journal of Clinical PracticeVolume 67, Issue 12 p. 1361-1361 ErratumFree Access Erratum This article corrects the following: Effects of niacin on the incidence of new onset diabetes and cardiovascular events in patients with normoglycaemia and impaired fasting glucose V. Sazonov, D. Maccubbin, C. McCrary Sisk, P. L. Canner, Volume 67Issue 4International Journal of Clinical Practice pages: 297-302 First Published online: March 24, 2013 First published: 19 November 2013 https://doi.org/10.1111/ijcp.12355AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Original Paper ‘Effects of niacin on the incidence of new onset diabetes and cardiovascular events in patients with normoglycaemia and impaired fasting glucose’. Int J Clin Pract 2013; 67: 297–302. In Table 3, the following n values should be corrected: ‘n = 6,341,560 should read n = 634, 1560; n = 354,888 should read n = 354, 888; n = 131,339 should read n = 131, 339; n = 4,051,394 should read n = 405, 1394; n = 456,900 should read n = 456, 900; n = 104,177 should read n = 104, 177; n = 3,181,165 should read n = 318, 1165; n = 346,941 should read n = 346, 941; and n = 301,365 should read n = 301, 365’. The conclusions remain unchanged. Reference 1Sazonov V, Maccubbin D, McCrary Sisk C, Canner PL. Effects of niacin on the incidence of new onset diabetes and cardiovascular events in patients with normoglycaemia and impaired fasting glucose. Int J Clin Pract 2013; 67: 297– 302. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume67, Issue12December 2013Pages 1361-1361 ReferencesRelatedInformation

Cardiogenic diabetes

It has been well established since the Framingham studies that diabetes mellitus is a risk factor for heart failure. Several recent reports suggested that the reverse is also true, and heart failure may also predispose to diabetes. We reviewed the literature and summarized the evidence of a higher incidence of new-onset diabetes in heart failure. Because a high rate of insulin resistance in heart failure is a known phenomenon, a higher incidence of diabetes in heart failure is intuitive. Although the facts confirming such connection is surprisingly scarce, we felt it was important to collect, analyze, and summarize the evidence.

Obesity in kidney transplant recipients: association with decline in glomerular filtration rate

In this study we aimed to evaluate the influence of obesity in kidney and patient survival and graft function. Retrospective cohort study of kidney transplant recipients performed between 2001 and 2009. The body mass index was calculated at time of transplantation, one and five years after. The main outcomes studied were incidence of delayed graft function, new onset diabetes after transplantation, patient and graft survival, and glomerular filtration rate. The prevalence of obesity and overweight patients were 10.7% and 26.8% respectively, with an increase to 16.9% and 32.5% one year after transplantation. Underweight and obese recipients presented a higher incidence of early graft loss. The incidence of new onset diabetes after transplantation was significantly higher at one and five years in overweight or obese recipients at baseline. Overweight and obese recipients presented significantly lower estimated glomerular filtration rate at five years posttransplantation (p = 0.002). In the Kaplan–Meier analyses no statistically significant differences in patients or grafts survivals were observed. Obese patients have a higher rate of early graft failure and a higher new onset diabetes after transplantation incidence. Also, the finding of decreased glomerular filtration rate is worrisome and perhaps longer follow-up will reveal more graft failures and patients deaths in the group of obese recipients.

Impact of the waist circumference change on new onset of diabetes in the population with impaired fasting glucose

To explore the impact of the waist circumference change on new onset diabetes (NOD) in the impaired fasting glucose (IFG) population. A total of 12 657 subjects who took part in the health examination from 2006 to 2007 and from 2010 to 2011 from the employees of Kailuan Group and met the inclusion criteria were selected as the observation cohort.Of the 12 657 subjects, 10 697 were male, 1960 were female, with age of (49.9 ± 11.3) years old. According to the baseline waist circumference (WC) measurements and its quartile in the health examinations during 2006 to 2007, the observation population was divided into four groups (first, second, third and the fourth quartile groups) . Multiple logistic regression analysis was used to test the relation between the increasing of WC and NOD. The incidences in the IFG population of NOD were 4.27% (1884/12 657) in the total population;4.25% (1581/10 697) in male and 4.44% (303/1960) in females, respectively (P < 0.05) . Along with increasing WC in the 4 quartile groups, the incidences of NOD was progressively increased, which were 2.19% (235/3083) , 3.07% (333/3114) , 4.47% (473/3037) and 7.08% (843/3423) , respectively;2.34% (213/2626) , 3.06% (282/2645) , 4.37% (393/2582), 7.00% (693/2844) in males and 1.38% (22/457) , 3.12% (51/469) , 5.05% (80/455) , 7.45% (150/579) in female (P < 0.05) . Multiple logistic regression analysis showed that compared with the first quartile group, the second, third and fourth quartile group had increased risk of NOD after adjusting for age, gender and other risk factors, the OR (95%CI) values were 1.38(1.13-1.68), 1.79 (1.47-2.09) and 3.10 (2.57-3.75), respectively. The incidence of NOD in the IFG population increased as the WC increased.

Effects of niacin on the incidence of new onset diabetes and cardiovascular events in patients with normoglycaemia and impaired fasting glucose

This post hoc analysis from the Coronary Drug Project (CDP) evaluated the effects of niacin vs. placebo on the incidence of new onset type 2 diabetes mellitus (T2DM) and cardiovascular event rates in patients with normal and impaired fasting glucose (IFG). The CDP was a randomised, placebo-controlled clinical trial of lipid-modifying agents in men with previous myocardial infarction. Normoglycaemia and IFG were defined as fasting plasma glucose (FPG) < 5.6 mmol/l and FPG ≥ 5.6 but < 7.0 mmol/l, respectively. New onset T2DM was defined by ≥ 1 of the following: clinical diagnosis of T2DM, use of an antihyperglycaemic therapy, or two FPG values ≥ 7.0 mmol/l. The incidence of new onset T2DM was higher in patients with IFG (16.5%) compared with those with normoglycaemia (5.4%), and was slightly higher with niacin vs. placebo in both normoglycaemic (6.8% vs. 4.9%; p = 0.07) and IFG (19.8% vs. 15.2%; p = 0.05) patients. Consistent with previous analyses, the cardiovascular benefit of niacin was independent of baseline glycaemic status (normal, IFG, T2DM) and change in fasting glucose level from baseline to year 1. Despite a modest increase in risk of new onset T2DM with long-term niacin therapy, there is a potential cardiovascular benefit of niacin.

Exercise Training in Solid Organ Transplant Recipients

Exercise training is effective in improving the cardiovascular risk profiles of nontransplanted patients, but the health benefits and potential harms of routine exercise training after solid organ transplantation are unclear. This study aims to assess the health benefits and harms of supervised exercise training programs in solid organ recipients. We systematically reviewed all randomized controlled trials (RCTs) comparing the outcomes of exercise training programs in solid organ recipients against standard care. MEDLINE, EMBASE, the Transplant Library from the Centre for Evidence in Transplantation, and the Cochrane Central Register of Controlled Trials were searched to June 2012. In total, 15 eligible RCTs involving 643 patients (9 cardiac transplants [n=250 patients], 2 kidney transplants [n=164 patients], 3 lung transplants [n=110 patients], and 1 liver transplant [n=119 patients]) were included. Cardiac transplant recipients who engaged in an exercise program after transplantation showed significant improvement in maximal oxygen uptake (standardized mean difference, 0.77; 95% confidence interval, 0.10-1.45) but no improvement in the overall serum lipid profile, blood pressure, and glycemic control compared with standard care. Among other solid organ transplant recipients, no significant improvements in exercise capacity or cardiovascular risk factors such as incidence of new-onset diabetes after transplantation were observed, but all effect estimates were very imprecise. Exercise training is a promising but unproven intervention for improving the cardiovascular outcomes of solid organ transplant recipients. Existing trials are small, of relatively short duration, and focused on surrogate outcomes. Large-scale RCTs are urgently required if resources are to be directed toward exercise programs.

Incidence and risk factors for new‐onset diabetes in living‐donor liver transplant recipients

With the increased number of long-term survivors after liver transplantation, new-onset diabetes after transplantation (NODAT) is becoming more significant in patient follow-up. However, the incidence of new-onset diabetes after living-donor liver transplantation (LDLT) has not been well elucidated. The aim of this study was to evaluate the incidence and risk factors for NODAT in adult LDLT recipients at a single center in Japan. A retrospective study was performed on 161 adult patients without diabetes who had been followed up for ≥threemonths after LDLT. NODAT was defined according to the 2003 American Diabetes Association/World Health Organization guidelines. The recipient-, donor-, operation-, and immunosuppression-associated risk factors for NODAT were assessed. Overall, the incidence of NODAT was 13.7% (22/161) with a mean follow-up of 49.8months. In a multivariate analysis, the identified risk factors for NODAT were donor liver-to-spleen (L-S) ratio (hazard ratio [HR]=0.022, 95% confidence interval [CI]=0.001-0.500, p=0.017), and steroid pulse therapy for acute rejection (HR=3.320, 95% CI=1.365-8.075, p=0.008). In conclusion, donor L-S ratio and steroid pulse therapy for acute rejection were independent predictors for NODAT in LDLT recipients. These findings can help in screening for NODAT and applying early interventions.