Author(s): Villanueva G, Baldwin D
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Abstract BACKGROUND: The new onset of posttransplant diabetes mellitus (PTDM) is a common problem after solid organ transplantation. Because insulin resistance plays a significant role in the development of PTDM, we treated 40 consecutive patients with PTDM after liver and kidney transplantation with the insulin sensitizer rosiglitazone (ROSI). METHODS: Thirty-three of 40 patients with PTDM were initially stabilized with twice-daily NPH and regular insulin. All patients subsequently began ROSI 4 mg per day. Patients were followed for a mean of 26 weeks and insulin was adjusted using home blood glucose data and hemoglobin A1C (HBA1C). RESULTS: During 12 months of study, 32/107 liver transplant patients (30\%) and 8/205 kidney transplant patients (4\%) patients developed PTDM. After 3-4 months of insulin and ROSI therapy, insulin was able to be discontinued in 30/33 (91\%) patients with PTDM. In all, 12/40 (30\%) patients maintained normal HBA1C levels (5.6+/-0.8\%) with ROSI monotherapy, whereas 25/40 (63\%) required ROSI and a sulfonylurea to meet this goal. Three of 40 (7.5\%) had persistent insulin dependence. 25/40 (63\%) continued on 4 mg/day of ROSI, and 15/40 (37\%) required an increase to 8 mg/day. Mild edema developed in 13\% of patients; significant weight gain did not occur. CONCLUSIONS: Rosiglitazone is the first highly effective oral agent for PTDM. The majority of patients with PTDM may be safely treated with ROSI +/- a sulfonylurea. After the expected 3-6 week delay in the onset of ROSI action, most patients with PTDM will no longer require long-term insulin therapy.
This article was published in Transplantation
and referenced in Journal of Nephrology & Therapeutics