Rosiglitazone therapy of posttransplant diabetes mellitus

Transplantation. 2005 Nov 27;80(10):1402-5. doi: 10.1097/01.tp.0000181165.19788.95.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cyclosporine / administration & dosage
  • Diabetes Mellitus, Type 2 / chemically induced*
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Insulin / therapeutic use
  • Kidney Transplantation / adverse effects
  • Liver Transplantation / adverse effects
  • Male
  • Middle Aged
  • Organ Transplantation / adverse effects*
  • PPAR gamma / agonists
  • Prospective Studies
  • Rosiglitazone
  • Tacrolimus / administration & dosage
  • Thiazolidinediones / therapeutic use*

Substances

  • Glycated Hemoglobin A
  • Insulin
  • PPAR gamma
  • Thiazolidinediones
  • Rosiglitazone
  • Cyclosporine
  • Tacrolimus