Early Treatment with NPH Insulin in Renal Transplantation and Diabetes Mellitus

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Abstract

Introduction

The therapeutic actions against the appearance of diabetes after renal transplantation have not been effective until now. The results of the administration of neutral protamine hagedorn (NPH) insulin regimen in the immediate post-transplant period suggest a reduction in the rate of post-transplant diabetes, possibly due to the protection of pancreatic beta cells.

Objective

The first aim was the evaluation of the presence of diabetes mellitus (DM) after renal transplantation at one year, between patients starting with NPH insulin regimen and other antidiabetic treatments in the immediate post-transplant period, and the second aim was to study the differences in patients with an early treatment of NPH who develop or not DM at 1 year.

Patients and Methods

A retrospective study of 100 renal transplant patients who received antidiabetic therapy (oral antidiabetic drugs (OAD) and/or insulin glargine) and early NPH treatment between 2013-2016. We collected clinical variables of renal receptor and transplantation, immunosuppressive induction treatment, prednisone 5 mg at 3 months, bacterial and cytomegalovirus (CMV) infections, beta-blockers, introduction and withdrawal of NPH, OAD and DM from the first year. The analytical variables were creatinine, albuminuria and tacrolimus level during the first year. Statistical package SPSS.

Results

The comparison between the group with NPH and other treatments did not show differences in sex (p = 0.548), dialysis type (p = 0.1), donation (p = 0.191), CKD etiology (p = 0.334), treatment of induction, beta-blockers (p = 0.287), bacterial infection (p = 0.434), CMV (p = 0.270), delayed graft function (p = 0.212), acute rejection (p = 0.09). All patients were treated with tacrolimus. There were significant differences in body mass index (BMI) (26.05 ± 3.99 vs 29.37 ± 3.99 kg / m2, p = 0.003). 66.7% of the patients with NPH developed DM in the first year postransplantation compared to 77.3% of patients with other antidiabetic therapies p = 0.028, OR = 0.244, IC = (0.069.0.861), controlling BMI (p = 0.607, CCR 72.5%).

Results

In the group of patients with NPH, the introduction of this was performed at 7.01 ± 4.67 days, the withdrawal was performed in 94.7% of them, at 86.68 ± 60.69 days, and 63.6% required OAD. There were no significant differences in the presence of DM at one year. 100% of the patients who presented DM needed OAD, compared to 50% of those who did not present it (p <0.0001). The withdrawal of NPH from patients with DM was at 133.28 ± 85.29 days compared to 66.18 ± 4.16 days of those who did not have it (p = 0.001).

Conclusions

-The introduction of NPH insulin in the immediate post-transplant in the patients studied, turned out to be a protective factor for the appearance of DM one year after transplantation in comparison with other antidiabetic therapies.

Conclusions

- The patients treated with NPH did not present differences for the development of DM at one year, requiring OAD and more days of treatment with NPH those who presented DM.

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