Thiazolidinediones in the treatment of patients with Post-Transplant-Hyperglycemia or new-onset diabetes mellitus after renal transplantation (NODAT) – A new therapeutic option?

Säemann, Marcus D.; Krebs, Michael

doi:10.1007/s00508-010-1369-2

Cited by 9 publications

(3 citation statements)

References 36 publications

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“…While metformin still remains the initial choice in the treatment of type 2 DM due to its potential pleiotropic effects and excellent safety profile, its widespread use in patients with impaired kidney function is prohibited at least in advanced chronic kidney disease (CKD) stages due to an increased risk of lactic acidosis . By increasing insulin sensitivity, thiazolidinediones may offer an interesting treatment alternative, although their use is problematic due to side effects such as weight gain, higher risk for congestive heart failure and osteoporosis, as well as bladder cancer . Sulfonylureas and meglitinides, which unspecifically increase insulin secretion, do not prevent or delay the loss of islet cells in diabetics, and lead to an increased hypoglycemia rate, especially in patients with CKD .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Vildagliptin in New-Onset Diabetes After Kidney Transplantation—A Randomized, Double-Blind, Placebo-Controlled Trial

Haidinger

Werzowa

Hecking

et al. 2014

American Journal of Transplantation

101

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New-onset diabetes after transplantation (NODAT) is a serious complication after kidney transplantation, but therapeutic strategies remain underexplored. Dipeptidyl peptidase-4 (DPP-4) inhibitors selectively foster insulin secretion without inducing hypoglycemia, which might be advantageous in kidney transplant recipients (KTRs) with NODAT. We conducted a randomized, double-blind, placebo-controlled, phase II trial to assess safety and efficacy of the DPP-4 inhibitor vildagliptin. Intraindividual differences in oral glucose tolerance test (OGTT)-derived 2-h plasma glucose (2HPG) from baseline to 3 months after treatment served as primary endpoint. Among secondary outcomes, we evaluated HbA1c, metabolic and safety parameters, as well as OGTTs at 1 month after drug discontinuation. Of 509 stable KTRs who were screened in our outpatient clinic, 63 (12.4%) had 2HPG !200 mg/dL, 33 of them were randomized and 32 completed the study. In the vildagliptin group 2HPG and HbA1c were profoundly reduced in comparison to placebo (vildagliptin: 2HPG ¼ 182.7 mg/dL, HbA1c ¼ 6.1%; placebo: 2HPG ¼ 231.2 mg/dL, HbA1c ¼ 6.5%; both p 0.05), and statistical significance was achieved for the primary endpoint (vildagliptin: 2HPG-difference À73.7 AE 51.3 mg/dL; placebo: À5.7 AE 41.4 mg/dL; p < 0.01). Adverse events were generally mild and occurred at similar rates in both groups. In conclusion, DPP-4 inhibition in KTRs with overt NODAT was safe and efficient, providing a novel treatment alternative for this specific form of diabetes.

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Vildagliptin in New-Onset Diabetes After Kidney Transplantation—A Randomized, Double-Blind, Placebo-Controlled Trial

Haidinger

Werzowa

Hecking

et al. 2014

American Journal of Transplantation

101

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“…Chronic kidneydiseases are characterized in that various kidneydiseases lead to substantive damage to the kidneyand induce disturbance of carbohydrate metabolism, clinically manifested by hyperglycemia and decrease in glucose tolerance. The diabetes secondary to hepatic substantive damage is called hepatic diabetes [8][9]. The pathogenesis of hepatic diabetes is primarily insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Regularity in Fasting Blood Sugar Variations and Influence Factors After Kidney Transplantation

Shao¹,

Xu²,

Yang³

2019

SJPH

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Objective To discuss the regularity in fasting blood sugar variations following kidneytransplantation and evaluate the PTDM morbidity and the effect of fasting blood sugar on survival and complications of patients. Method 422 patients receiving kidneytransplantation in our hospital from January 2015 to December 2018 were collected. Based on the pre-operative fasting blood sugar, the patients were divided into Group DM, IFG, and NFG. The variation trends of fasting blood sugar in various groups were obtained by analysing the fasting blood sugar data of patients 3, 6, 9, 12, 24, 36, 48, and 60 months before and after operation. The PTDM occurrence conditions were analysed 3, 6, 9, 12, 36, and 60 months after operation based on the fasting blood sugar of patients; a simplified OGTT was performed for patients with their fasting blood sugar not meeting the diagnostic criteria for diabetes ≥3 years after kidneytransplantation to analyse the PTDM morbidity among patients ≥3 years after kidneytransplantation and calculate the HOMA index. The patients were divided into Group DM, IFG, and NFG based on fasting blood sugar before kidneytransplantation and PTDM Group and Non-PTDM Group. A comparison was made for the difference in survival rate among various groups. Result The fasting blood sugar in the Group DM decreased significantly compared with that before operation (P<0.05); the fasting blood sugar in the Group IFG and NFG increased compared that before operation (P<0.05). The PTDM morbidity exhibited an overall decreasing trend with time and reached as high as 52.82% 3 months after operation. HOMA-IR was the highest in Group IGR followed by Group PTDM. HOMA-IR significantly increased in Group IGR compared with the group of normal blood sugar (P<0.05). HOMA-β in Group PTDM decreased significantly compared with the group of normal blood sugar and Group IGR (P<0.05). The survival rate in Group DM significantly decreased compared with that in Group NFG (P<0.05); the survival rate in Group IFG also decreased significantly compared with that in Group NFG (P<0.05); the average survival time and survival rate in Group PTDM were significantly lower than those in groups other than Group PTDM (P<0.05). Conclusion kidneytransplantation is able to improve the fasting blood sugar of patients with diabetes and the blood sugar can significant affect the survival rate of kidneytransplantation patients and lower the survival rate of patients.

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“…To date, metformin remains the first choice for oral pharmacological treatment of type 2 DM due to its pleiotropic effects and excellent safety profile, but its use in patients with advanced chronic kidney disease (CKD) is limited by the increased risk of lactic acidosis . The thiazolidinedione pioglitazone might constitute an interesting treatment alternative through its ability to increase insulin sensitivity, but the occurrence of multiple side effects such as weight gain, increased risk of congestive heart failure, and osteoporosis as well as bladder cancer renders its use controversial . Nevertheless, a randomized, controlled, double‐blind trial in kidney transplant recipients (KTRs) with disturbed glucose metabolism demonstrated a good safety and efficacy profile of pioglitazone, although no long‐term data are available .…”

mentioning

confidence: 99%

Post‐transplantation diabetes mellitus: evaluation of treatment strategies

Haidinger

Antlanger

Kopecky

et al. 2015

Clinical Transplantation

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Thiazolidinediones in the treatment of patients with Post-Transplant-Hyperglycemia or new-onset diabetes mellitus after renal transplantation (NODAT) – A new therapeutic option?

Cited by 9 publications

References 36 publications

Efficacy and Safety of Vildagliptin in New-Onset Diabetes After Kidney Transplantation—A Randomized, Double-Blind, Placebo-Controlled Trial

Efficacy and Safety of Vildagliptin in New-Onset Diabetes After Kidney Transplantation—A Randomized, Double-Blind, Placebo-Controlled Trial

An Analysis of Regularity in Fasting Blood Sugar Variations and Influence Factors After Kidney Transplantation

Post‐transplantation diabetes mellitus: evaluation of treatment strategies

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