Risk Of New-onset Diabetes Research Articles

Association of baseline remnant cholesterol independent of LDL-cholesterol with newly diagnosed diabetes in the Chinese population.

Remnant cholesterol (RC) is highly regarded in the cardiovascular field; however, its relationship with new-onset diabetes remains unclear. This study aimed to investigate the relationship between RC and the risk of developing diabetes, as well as its interaction with low-density lipoprotein cholesterol (LDL-c). This was a secondary analysis of a retrospective cohort study based on a Chinese population. A multivariate Cox proportional hazards regression was initially employed to assess the relationship between RC and newly diagnosed diabetes. This was followed by a subgroup analysis to explore intergroup heterogeneity. A clinical prediction model was then developed. Finally, the study further analyzed the interactions between LDL-c and RC. After adjusting for confounding factors, RC was significantly associated with an increased risk of diabetes (HR = 1.46, 95% CI 1.36-1.57). Furthermore, this relationship was nonlinear, with an inflection point of 0.48 identified through the piecewise model. Subgroup analysis indicated that the association was more pronounced in individuals under 60 years and those with a BMI <24 kg/m2 (P for interaction=0.0004, <0.0001, respectively). RC proved to be a more effective predictor of diabetes compared to other lipid profiles, and the clinical prediction model was successfully constructed. Notably, individuals in the low LDL-c/high RC group were found to have a 1.41-fold (95% CI 1.28-1.55) greater risk compared to those in the low LDL-c/low RC group. Significant correlations were observed between baseline RC levels and the risk of new-onset diabetes. Elevated RC was a strong predictor of diabetes risk, irrespective of LDL-c levels.

Association of hypertension and long-term blood pressure changes with new-onset diabetes in the elderly: A 10-year cohort study.

To explore the correlation between new-onset diabetes (NOD), hypertension and blood pressure management among elderly individuals in China. A cohort analysis involved 1380 participants aged 60 years or older, initially free of diabetes in 2008, from the Chinese Longitudinal Healthy Longevity Survey. Follow-up assessments occurred every 2-3 years. The relationship between hypertension, blood pressure changes and NOD was analysed using multivariable-adjusted Cox regression. By 2018, 102 participants developed diabetes, while 1278 remained without diabetes. The cumulative diabetes prevalence increased from 3.1% at 3 years to 7.4% at 10 years. Hypertension prevalence increased from 20.9% at baseline to 41.0% at 10 years, with higher rates in those diagnosed with diabetes during follow-up. Multivariate analysis identified age, gender, baseline hypertension and systolic blood pressure (SBP) as independent predictors of NOD. Hypertension combined with overweight/obesity significantly increased the risk of NOD (hazard ratio [HR] 2.837; 95% confidence interval [CI], 1.680-4.792). We evaluated participants' blood pressure management levels in 2008 and 2011, then tracked the onset of diabetes from 2011 to 2018. Compared with participants with an average SBP below 120 mmHg in 2008 and 2011, those with SBP of 140 mmHg or higher had an 8-fold higher risk of developing NOD (adjusted HR8.492, 95% CI 2.048-35.217, P = .003), the highest risk group. Participants with SBP of 130-139.9 mmHg also had a significantly increased risk (adjusted HR 5.065, 95% CI 1.186-21.633, P = .029), while those with SBP of 120-129.9 mmHg showed no significant difference (HR 2.730, 95% CI 0.597-12.481, P = .195). Consistently high SBP (≥ 130 mmHg) further increased NOD risk (adjusted HR 3.464, 95% CI 1.464-8.196, P = .005). Significant predictors of NOD included age, gender, baseline hypertension and blood pressure management. Maintaining SBP consistently below 130 mmHg may be an effective strategy to reduce the incidence of NOD in the general elderly population.

Impact of Statin Therapy on Diabetes Incidence: Implications for Primary Prevention

Abstract Purpose of Review The present review aims to summarize current evidence, explore underlying mechanisms, and help guide clinicians regarding statin therapy and diabetes risk in primary prevention. Recent Findings The observational and genetic epidemiology, as well as evidence from randomized controlled trials and meta-analyses, illustrate a modest, dose-dependent increase in risk of diabetes from statin therapy. Summary Risk of new onset diabetes from statins appears to be greatest in those near the diagnostic threshold for diabetes or with diabetes risk factors prior to statin initiation. The risk of incident diabetes is vastly offset by the cardiovascular protection offered from statin therapy and should not deter guideline recommended statin initiation in primary prevention.

Risk of New-Onset Diabetes Before and During the COVID-19 Pandemic: A Real-World Cohort Study

Risk of New-Onset Diabetes Before and During the COVID-19 Pandemic: A Real-World Cohort Study

Associations of very low Lipoprotein(a) levels with risks of new-onset diabetes and non-alcoholic liver disease

Background and aimsWe aimed to study the association of very low serum Lipoprotein(a) [Lp(a)] concentrations with new-onset type 2 diabetes (T2D) and non-alcoholic liver disease (NAFLD) in the context of statin usage in the UK Biobank, a large prospective population cohort. MethodsUsing an extended biomarker dataset, we identified 47,362 participants with very low Lp(a) concentrations (<3.8 nmol/L) from a total of 451,479 participants. With a median follow-up of 12.3 years, we assessed the risk of new-onset cardiometabolic diseases in participants stratified by statin usage with Cox proportional hazards models. We performed two-sample Mendelian randomization MR analyses to test causal relationship between genetically predicted Lp(a) and T2D and NAFLD. ResultsTaking the participants with Lp(a) within reportable range as the reference group, the hazard ratios (HR) for T2D were 1.07 (95 % confidence interval, CI 1.01–1.13) and for NAFLD 1.30 (95 % CI 1.20–1.41) respectively for participants with very low Lp(a) (<3.8 nmol/L). The risk for new-onset T2D was higher in participants using statins (adjusted HR 1.15; 95 % CI 1.05–1.27). The risk estimates for new-onset NAFLD were comparable in the analysis stratified by statin use. There was no evidence for causal links between genetically predicted Lp(a) and T2D nor NAFLD in two-sample MR analyses. ConclusionsVery low Lp(a) was associated with higher risks of T2D and NAFLD in a prospective analysis of the UK Biobank. The association with T2D was influenced by lipid lowering medication usage. MR analyses did not support causality for these inverse associations.

Adjustment for sparse data bias in odds ratios: Significance to appraisal of risk of diabetes due to occupational trichlorfon insecticide exposure

BackgroundBias away from the null in odds ratios (OR), aggravated by low power, is a well-known phenomenon in statistics (sparse data bias). Such bias increases in presence of selection of “significant” results on the basis of null hypothesis testing (effect size magnification, ESM). ObjectivesWe seek to illustrate these issues and adjust for suspected sparse data bias in the context of a reported more than doubling of the odds of new onset type 2 diabetes in presence of occupational trichlorfon insecticide exposure reported in the Agricultural Health Study. MethodsWe performed ESM analysis on the crude ORs extracted from the contingency table in the published report, which is done by simulating selected OR given a posited true OR. Next, we applied easily accessible methods that adjust for sparse data bias to the extracted contingency tables, including data augmentation, bootstrap, Firth's regression, and Bayesian methods with weakly informative priors. ResultsDuring the ESM analysis, we observed that there was a reasonable chance that a “statistically significant” OR of around 2.5–2.6 would be observed for true OR of 1.2. Adjustment for sparse data bias revealed that Bayesian methods outperformed alternative approaches in terms of yielding more precise inference, while not making unjustified distributional assumptions about estimates of OR. The OR in the original paper of about 2.5–2.6 was reduced on average to OR of 1.9 to 2.2, with 95% (Bayesian) credible intervals that included the null. DiscussionIt is reasonable to adjust ORs for sparse data bias when the reported association has societal importance, because policy must be informed by the least biased estimates of the effect. We think that such adjustment would lead to a more appropriate evaluation of the extent of evidence on the contribution of occupational exposure to trichlorfon pesticide to risk of new onset diabetes.

The association between multiple trajectories of macronutrient intake and the risk of new-onset diabetes in Chinese adults.

The association between macronutrient intake and diabetes is unclear. We used data from the China Health and Nutrition Survey to explore the association between macronutrient intake trajectories and diabetes risk in this study. We included 6755 participants who did not have diabetes at baseline and participated in at least three surveys. The energy supply ratio of carbohydrate, protein, and fat was further calculated from dietary data; different macronutrient trajectories were determined using multitrajectory models; and multiple Cox regression models were used to evaluate the association between these trajectories and diabetes. We found three multitrajectories: decreased low carbohydrate-increased moderate protein-increased high fat (DLC-IMP-IHF), decreased high carbohydrate-moderate protein-increased low fat (DHC-MP-ILF), and balanced-macronutrients (BM). Compared to the BM trajectory, DHC-MP-ILF trajectories were significantly associated with increased risk of diabetes (hazard ratio [HR]: 3.228, 95% confidence interval [CI]: 1.571-6.632), whereas no association between DLC-IMP-IHF trajectories and diabetes was found in our study (HR: 0.699, 95% CI: 0.351-1.392). The downward trend of high carbohydrate and the increasing trend of low fat increased the risk of diabetes in Chinese adults.

Hidroksi Metil Glutaril Coenzyme-A (HMG CoA) Reduktase Inhibitor and New Onset Diabetes Mellitus: A Review of Correlation and Clinical Implication

Treatment of lipid abnormalities with HMG CoA reductase inhibitor (statin) has been used for diabetic and non diabetic patients. Various studies have describe increased risk of new onset diabetes associated with statin therapy. This review aims to explain potential mechanism that related to diabetogenic effect of statin. This research was created by collecting literature that relevant to the topic. The types of literature used are clinical trials, meta analyzes and systematic reviews between 2013 until 2021. HMG CoA reductase is the target of statin therapy and the acting of this enzyme is inhibited by statin in competitive way. In vivo and in vitro studies reveal that statin reduce synthesis of mevalonate pathway and increase cholesterol transport that influence B cell function and decrease of insulin sensitivity and insulin secretion by multiple mechanism. Recent genetic study suggest that increased risk of type 2 diabetes mellitus pathway explained by gene variant target for LDL cholesterol lowering drugs. Accumulating evidence from several statin studies suggest that pravastatin is the least diabetogenic statin. Simvastatin, atorvastatin and rosurvastatin are more diabetogenic statin. The used of statin in clinical practice should concerned about benefit on cardiovascular while still considering the possible risk of developing type 2 diabetes mellitus. Regular monitoring of patients glycemic control is mandatory

Primary hypocholesterolemia and risk of new-onset diabetes in general population

Primary hypocholesterolemia and risk of new-onset diabetes in general population

IDF2022-0086 Meta-analysis of Association between TCF7L2 rs7903146 and Risk of New-Onset Diabetes After Transplantation

IDF2022-0086 Meta-analysis of Association between TCF7L2 rs7903146 and Risk of New-Onset Diabetes After Transplantation

WCN23-0602 Meta-analysis of Association between TCF7L2 rs7903146 and Risk of New-Onset Diabetes After Transplantation

WCN23-0602 Meta-analysis of Association between TCF7L2 rs7903146 and Risk of New-Onset Diabetes After Transplantation

CLINICAL COURSE OF MEDICALLY MANAGED PATIENTS WITH LARGE AND SMALL DUCT CHRONIC PANCREATITIS.

Pancreatic duct obstruction is the primary indication for endoscopic and/or surgical therapy in patients with chronic pancreatitis (CP). However, the clinical course of medically managed patients in relation to pancreatic duct obstruction is largely unknown. This was a retrospective cohort study of medically managed CP patients. We classified patients based on pancreatic duct obstruction from a stricture or stone using cross-sectional imaging (i.e., large vs small duct CP). We compared prevalence of diabetes and exocrine insufficiency (EPI) between subgroups at inclusion and investigated risk of new onset diabetes, EPI, and all-cause mortality over a follow-up period of 5 years. Changes in pancreatic morphology were studied in patients who underwent follow-up imaging. A total of 198 patients (mean age 58 ± 12 years, 70% male, 60% alcoholic aetiology, 38% large duct CP) were evaluated. At inclusion, patients with large vs small duct CP had a higher prevalence of both diabetes (43% vs 24%, P=0.004) and EPI (47% vs 28%, P=0.007). There was an increased risk of new onset EPI in patients with large duct CP (hazard ratio 1.72; 95% CI [1.05-2.80], P=0.031) and higher rates of pancreatic atrophy (P<0.001). No differences between groups were observed for new onset diabetes and all-cause mortality. Conversion from small to large duct CP or vice versa during follow-up was observed in 14% of patients. In a medically managed cohort of patients, large duct CP was associated with increased risk of EPI and pancreatic atrophy compared to small duct CP.

Acute sarcopenia and risk of new-onset diabetes in coronavirus disease 2019 patients

Acute sarcopenia and risk of new-onset diabetes in coronavirus disease 2019 patients

Impact of high-intensity statin therapy on glycemic control post-acute coronary syndrome using real-world data

Abstract Background Statins use has been linked with increased risk of new onset diabetes and impaired glycemic control in the JUPITER trial and meta-analyses of randomized controlled trials. Nevertheless, the evidence is scarce in the real-world clinical settings, particularly among those receiving high-intensity statin post-acute coronary syndrome (ACS). Methods We conducted a retrospective observational study to determine the impact of statin use post-ACS on glycosylated hemoglobin (HbA1c) and the incidence of diabetes. The study included adults admitted with ACS between January 1, 2017 and December 31, 2018 and newly started on a high-intensity statin (rosuvastatin or atorvastatin). The outcomes assessed within 12 months of statin initiation were: (a) HbA1c before and after statin use among diabetic and non-diabetic patients; (b) incidence of diabetes. Paired sample t-test was used to compare HbA1c values pre and post statin use. Results Of the 1,253 patients included, 627 received rosuvastatin and 626 received atorvastatin following ACS. Most of the patients were Asian (77.3%), male (95.8%) with a median age of 51 years. The baseline HbA1c was 7.2±2.2% and 45% of the study population were diabetic at baseline. Among non-diabetic patients, statin use resulted in HbA1c increase from 5.7±0.7% to 6.0±0.8%, p&amp;lt;0.001, while among diabetic patients who were receiving treatment for diabetes, HbA1c decreased from 8.8±1.9% to 7.8±1.9%, p&amp;lt;0.001. New onset diabetes occurred in 41 (6%) of the non-diabetic patients, of whom 13 (1.9%) were receiving atorvastatin, while 28 (4.1%) were on rosuvastatin, p-value = 0.032. The use of both statins resulted in a significant increase of HbA1c among non-diabetic patients as demonstrated in Figure 1. Conclusion High intensity statin post-ACS was associated with increased HbA1c among non-diabetic patients. In particular, rosuvastatin significantly increased the new onset of diabetes compared to atorvastatin which might provide preference of atorvastatin use over rosuvastatin among non-diabetic patients post-acute coronary syndrome. Funding Acknowledgement Type of funding sources: None.

Plasma level of ATPase inhibitory factor 1 (IF1) is associated with type 2 diabetes risk in humans: A prospective cohort study

AimMitochondrial dysfunction is associated with the development of type 2 diabetes mellitus (T2DM). It is thus of clinical relevance to identify plasma biomarkers of mitochondrial dysfunction associated with the risk of T2DM.ATPase inhibitory factor 1 (IF1) endogenously inhibits mitochondrial ATP synthase activity. Here, we analyzed association of the plasma IF1 level with markers of glucose homeostasis and with the conversion to new-onset diabetes (NOD) in individuals with prediabetes. MethodsIn the IT-DIAB prospective study, the baseline plasma level of IF1 was measured in 307 participants with prediabetes. The primary outcome was the incidence of NOD within five years of follow-up. Cross-sectional analysis of the IF1 level was also done in two independent interventional studies. Correlations between plasma IF1 and metabolic parameters at baseline were assessed by Spearman's correlation coefficients, and the association with the risk of NOD was determined using Cox proportional‐hazards models. ResultsIn IT-DIAB, the mean IF1 plasma level was lower in participants who developed NOD than in those who did not (537 ± 248 versus 621 ± 313 ng/mL, P = 0.01). The plasma IF1 level negatively correlated with clinical variables associated with obesity and insulin resistance, including the body mass index (r = −0.20, P = 0.0005) and homeostasis model assessment of insulin resistance (HOMA-IR). (r = −0.37, P < 0.0001). Conversely, IF1 was positively associated with plasma markers of cardiometabolic health, such as HDL-C (r = 0.63, P < 0.0001) and apoA-I (r = 0.33, P < 0.0001). These correlations were confirmed in cross-sectional analyses. In IT-DIAB, the IF1 level was significantly associated with a lower risk of T2DM after adjustment for age, sex, and fasting plasma glucose (HR [95% CI] per 1 SD = 0.76 [0.62; 0.94], P = 0.012). ConclusionWe identified for the first time the mitochondrial-related biomarker IF1 as being associated with the risk of T2DM.

Hepatocyte Rap1a contributes to obesity- and statin-associated hyperglycemia.

SUMMARYExcessive hepatic glucose production contributes to the development of hyperglycemia and is a key feature of type 2 diabetes. Here, we report that activation of hepatocyte Rap1a suppresses gluconeogenic gene expression and glucose production, whereas Rap1a silencing stimulates them. Rap1a activation is suppressed in obese mouse liver, and restoring its activity improves glucose intolerance. As Rap1a′s membrane localization and activation depends on its geranylgeranylation, which is inhibited by statins, we show that statin-treated hepatocytes and the human liver have lower active-Rap1a levels. Similar to Rap1a inhibition, statins stimulate hepatic gluconeogenesis and increase fasting blood glucose in obese mice. Geranylgeraniol treatment, which acts as the precursor for geranylgeranyl isoprenoids, restores Rap1a activity and improves statin-mediated glucose intolerance. Mechanistically, Rap1a activation induces actin polymerization, which suppresses gluconeogenesis by Akt-mediated FoxO1 inhibition. Thus, Rap1a regulates hepatic glucose homeostasis, and blocking its activity, via lowering geranylgeranyl isoprenoids, contributes to statin-induced glucose intolerance.

Abstract 5880: Diabetes incidence after obesity-related cancer diagnosis and survival in the women’s health initiative

Abstract Introduction: Obesity-related cancer (ORC) diagnosed individuals are at an elevated risk of new-onset diabetes compared with cancer-free individuals. However, less is known about mortality among those with incident type 2 diabetes after cancer. Methods: In the Women’s Health Initiative (N=14,455 ORC cases), we measured the association of incident type 2 diabetes diagnosed 0-1 years, &amp;gt;1-3, &amp;gt;3-5, &amp;gt;5-7 and &amp;gt;7-10 years after ORC diagnosis with cancer-specific and overall mortality using stratified Cox proportional hazards regression analysis. Results: The participants were post-menopausal females with ORC and predominantly white. The number of WHI participants with ORC who developed diabetes after cancer diagnosis were: 0-1 years - 205/12992 (1.58%); 1-3 years - 326/11322 (2.88%); 3-5 years - 276/9784 (2.82%); 5-7 years - 268/8420 (3.18%); and 7-10 years - 510/6419 (7.95%). The median survival after the first year of cancer diagnosis for participants without diabetes was 16.6 years (95% CI: 16.17-17.0 years) and for those with diabetes was 10.3 years (95% CI: 7.97-14.9 years). New-onset diabetes after ORC diagnosis showed elevated overall mortality and cancer-specific mortality when compared with no diabetes diagnosis. Conclusions: Incident type 2 diabetes is associated with worse cancer-specific and overall survival, particularly in the year after diagnosis, among women with ORC. Type 2 Diabetes from time since cancer diagnosis Overall mortality HR (95% CI)a Cancer-specific mortality HR (95% CI)a 0-1 years 1.79 (1.41-2.29) 1.56 (1.04-2.34) &amp;gt;1-3 years 1.22 (0.99-1.51) 1.05 (0.72-1.55) &amp;gt;3-5 years 1.21 (0.95-1.55) 1.37 (0.89-2.12) &amp;gt;5-7 years 1.02 (0.78-1.33) 0.80 (0.47-1.36) &amp;gt;7-10 years 1.10 (0.87-1.40) 0.97 (0.59-1.60) aModel adjusted for demographics (age, education, race/ethnicity, marital status), body mass index (BMI)) and cancer characteristics (cancer type, stage, grade). CI = confidence interval; HR = Hazard ratio. Citation Format: Prasoona Karra, Maci Winn, Benjamin Haaland, Garnet Anderson, Cynthia A. Thomson, Aladdin H. Shadyab, Juhua Luo, Nazmus Saquib, Howard Strickler, Rowan Chlebowski, Rhonda Arthur, Sheetal Hardikar, Mary C. Playdon. Diabetes incidence after obesity-related cancer diagnosis and survival in the women’s health initiative [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5880.

190-OR: Increased Risk of Incident Diabetes after Therapy with Immune Checkpoint Inhibitor Compared with Conventional Chemotherapy: A Longitudinal Trajectory Analysis Using a Tertiary Care Hospital Database

Immune checkpoint inhibitors (ICI) have been emerged as a promising option for cancer treatments. However, ICI use induces immune-related adverse events including diabetes mellitus. We investigated the risk of new-onset diabetes in patients receiving ICI compared with conventional chemotherapy (CC) . Using a tertiary care hospital database, we included cancer patients without previous history of diabetes and treated with either CC or ICI. One-to-five nearest neighbor propensity matching was applied, and the risk for diabetes was estimated using a Cox proportional hazards model. Latent class growth modeling was performed in a trajectory approach to determine distinct clusters following a similar glucose trajectory pattern over time. Of 1,326 subjects, 1,1received CC, and 221 received ICI. The ICI group had a significantly higher cumulative incidence of diabetes compared with those in the CC group (log-rank p &amp;lt; 0.001) . In addition, the risk of new-onset diabetes was significantly increased in the ICI group compared to the CC group (adjusted hazard ratio 2.454, 95% confidence interval 1.528-3.940; p &amp;lt; 0.001) . The proportion of subjects in the trajectory cluster with an increasing glucose pattern was higher in the ICI group than in the CC group (10.4% for the ICI group and 7.4% for the CC group) . Among the ICI group, subjects with an increasing glucose pattern were predominantly male and associated with enhanced lymphocytosis after ICI administration. In conclusion, ICI therapy is associated with an increased risk of incident diabetes compared with CC. Glucose levels in the subjects treated with ICI need to be regularly monitored for earlier detection of ICI-associated diabetes, especially males and those with prominent lymphocytosis after ICI treatment. Disclosure K.Jeong: None. M.Lee: None. Y.Park: None. Y.Rhee: None. Funding Grant of the Korea Health Technology R&amp;D Project through the Korea Health Industry Development Institute (KHIDI) , funded by the Ministry of Health &amp; Welfare, Republic of Korea. (grant number: HI19C0189) , and the Bio &amp; Medical Technology Development Program of the National Research Foundation (NRF) , funded by the Korean government (MSIT) (NRF2019M3E5D4064682) .

161-LB: Intensive Blood Pressure Lowering and the Risk of New-Onset Diabetes in Patients with Hypertension—A Post Hoc Analysis of the STEP Randomized Trial

Background: The STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) trial reported the cardiovascular benefit of intensive blood pressure (BP) control. The objective of this analysis was to evaluate the effect of intensive BP lowering on the new-onset diabetes incidence. Methods: The patients of STEP who had a baseline fasting serum glucose (FSG) &amp;lt;7.0 mmol/L without diabetes history and hypoglycemic medication use were included in the main analysis. The primary outcome was the new-onset diabetes, defined as the time to first occurrence of a FSG ≥7.0 mmol/l. The secondary outcome was the new-onset impaired fasting glucose (IFG: FSG 5.6-6.9 mmol/l) among patients with normoglycemia. The competing risk proportional hazards regression model was used in the main analysis. Results: Over a median follow-up of 3.42 years, 273 (9.6%) in the intensive group and 262 (9.5%) in the standard group developed new-onset diabetes (adjusted HR 1.03; 95% CI 0.87-1.22) . The adjusted hazard ratio for the secondary outcome was 1.05 (95% CI 0.92-1.19) . The mean of the highest FSG was 5.82 mmol/l for intensive group and 5.84 mmol/l for standard group. The sensitivity analyses showed no significant difference with respect to the effect of the treatment arms. Conclusions: Intensive BP lowering (target, 110 to &amp;lt;130 mmHg) , as compared with standard BP lowering (target, 130 to &amp;lt;150 mmHg) , did not increase the risk of new-onset diabetes and IFG in patients with hypertension. Disclosure R. Yang: None. J. Cai: None.

Risk of New-Onset Diabetes after Transplantation among Kidney Transplant Recipients with Cytomegalovirus Infection: A Retrospective Analysis

Background: New-onset diabetes after transplantation (NODAT) is one of the common complications reported in patients with kidney transplant and is associated with risk of infection, poor allograft and patient survival. There is conflicting research literature regarding the role of cytomegalovirus (CMV) infection in increasing the risk of NODAT development. Objective: To assess the risk of development of NODAT in kidney transplant patients with CMV infection Methods: A total of 59 kidney transplant patients were studied from March 2017 to February 2019. NODAT was defined as two readings of fasting plasma glucose of ≥126 mg/dL at three months post-transplant. CMV viral load was also documented. The 12 months post-transplant allograft and patient survival outcomes were also measured. Results: Mean age was 43.4 ± 6.2 years. Nearly one-fourth, 14 (23.7%), of the patients had NODAT. CMV viral load and viremia were high in NODAT group; however, the result did not reach statistical significance. CMV DNA replication was statistically high during 1-6 months post-transplant for NODAT group (P&lt;0.001). Only 7 (11.9%) recipients advanced to symptomatic CMV infection. Also, we found that high CMV viremia load was associated with poor kidney allograft function at 12 months. Conclusions: In summary, this study showed that infection with CMV may not be a risk factor to develop NODAT in patients transplanted with kidney. An elevated CMV viral load may decrease the post-transplant allograft function at 12 months. The prompt diagnosis and timely management of CMV infection could substantially lessen the risk to develop NODAT subsequent worsening of allograft and patient survival. Keywords: Kidney; Transplant; NODAT; New-onset Diabetes; Cytomegalovirus