BACKGROUND Solid organ transplantation is a life-saving intervention for end-stage organ disease.Post-transplant diabetes mellitus(PTDM)is a common complication in solid organ transplant recipients,and significantly c...BACKGROUND Solid organ transplantation is a life-saving intervention for end-stage organ disease.Post-transplant diabetes mellitus(PTDM)is a common complication in solid organ transplant recipients,and significantly compromises long-term survival beyond a year.AIM To perform a systematic review and meta-analysis to estimate incidence of PTDM and compare the effects of the 3 major immunosuppressants on incidence of PTDM.METHODS Two hundred and six eligible studies identified 75595 patients on Tacrolimus,51242 on Cyclosporine and 3020 on Sirolimus.Random effects meta-analyses was used to calculate incidence.RESULTS Network meta-analysis estimated the overall risk of developing PTDM was higher with tacrolimus(OR=1.495%CI:1.0–2.0)and sirolimus(OR=1.8;95%CI:1.5–2.2)than with Cyclosporine.The overall incidence of PTDM at years 2-3 was 17%for kidney,19%for liver and 22%for heart.The risk factors for PTDM most frequently identified in the primary studies were age,body mass index,hepatitis C,and African American descent.CONCLUSION Tacrolimus tends to exhibit higher diabetogenicity in the short-term(2-3 years post-transplant),whereas sirolimus exhibits higher diabetogenicity in the longterm(5-10 years post-transplant).This study will aid clinicians in recognition of risk factors for PTDM and encourage careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.展开更多
A common challenge in managing kidney transplant recipients(KTR)is posttransplant diabetes mellitus(PTDM)or diabetes mellitus(DM)newly diagnosed after transplantation,in addition to known pre-existing DM.PTDM is an im...A common challenge in managing kidney transplant recipients(KTR)is posttransplant diabetes mellitus(PTDM)or diabetes mellitus(DM)newly diagnosed after transplantation,in addition to known pre-existing DM.PTDM is an important risk factor for post-transplant cardiovascular(CV)disease,which adversely affects patient survival and quality of life.CV disease in KTR may manifest as ischemic heart disease,heart failure,and/or left ventricular hypertrophy.Available therapies for PTDM include most agents currently used to treat type 2 diabetes.More recently,the use of sodium glucose co-transporter 2 inhibitors(SGLT2i),glucagon-like peptide-1 receptor agonists(GLP-1 RA),and dipeptidyl peptidase 4 inhibitors(DPP4i)has cautiously extended to KTR with PTDM,even though KTR are typically excluded from large general population clinical trials.Initial evidence from observational studies seems to indicate that SGLT2i,GLP-1 RA,and DPP4i may be safe and effective for glycemic control in KTR,but their benefit in reducing CV events in this otherwise high-risk population remains unproven.These newer drugs must still be used with care due to the increased propensity of KTR for intravascular volume depletion and acute kidney injury due to diarrhea and their single-kidney status,pre-existing burden of peripheral vascular disease,urinary tract infections due to immunosuppression and a surgically altered urinary tract,erythrocytosis from calcineurin inhibitors,and reduced kidney function from acute or chronic rejection.展开更多
目的分析妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清脂肪因子及一般生化指标水平的异常变化,研究其联合监测对GDM的临床意义。方法纳入该院GDM孕妇50例,正常孕妇50例,正常健康对照组50例,对孕妇组进行孕中期和孕晚期空...目的分析妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清脂肪因子及一般生化指标水平的异常变化,研究其联合监测对GDM的临床意义。方法纳入该院GDM孕妇50例,正常孕妇50例,正常健康对照组50例,对孕妇组进行孕中期和孕晚期空腹血糖、空腹胰岛素(insulin,ins)、血清胆固醇(cholesterol,CHOL)、三酰甘油(triglyceride,TG)、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、甘丙肽(galanin,GAL)、脂联素(adiponectin,APN)的水平监测,同时监测正常对照组相关指标。结果孕中期,正常对照组GAL水平低于正常孕妇组,GDM组的空腹血糖、HOMA-IR、TG和GAL水平显著高于正常对照组。孕晚期,正常对照组血清HDL、LDL、GAL水平显著低于正常孕妇组,APN水平高于正常孕妇组,GDM组空腹INS、HOMA-IR、HDL和GAL水平显著高于正常对照组,APN水平明显低于正常对照组。孕中期GDM组空腹血糖、HOMA-IR、TG和GAL水平显著高于正常孕妇组,孕晚期空腹血糖和GAL水平差异具有统计学意义。孕中期GAL与空腹血糖、空腹ins、HOMA-IR、TG呈正相关,孕中期APN与空腹血糖、空腹ins、HOMA-IR、TG和LDL呈负相关。孕晚期GAL与空腹血糖、空腹ins、HOMA-IR、TG、LDL呈正相关,孕晚期APN与空腹血糖、空腹ins、HOMA-IR和LDL呈负相关。结论 GDM与血清脂肪因子水平呈密切相关,血清脂肪因子联合一般生化指标监测对GDM的发生和发展的预测和评估具有重要意义。展开更多
Solid organ transplantation offers life-saving treatment for patients with endorgan dysfunction.Patient survival and quality of life have improved over the past few decades as a result of pharmacological development,e...Solid organ transplantation offers life-saving treatment for patients with endorgan dysfunction.Patient survival and quality of life have improved over the past few decades as a result of pharmacological development,expansion of the donor pool,technological advances and standardization of practices related to transplantation.Still,transplantation is associated with cardiovascular complications,of which post-transplant diabetes mellitus(PTDM)is one of the most important.PTDM increases mortality,which is best documented in patients who have received kidney and heart transplants.PTDM results from traditional risk factors seen in patients with type 2 diabetes mellitus,but also from specific posttransplant risk factors such as metabolic side effects of immunosuppressive drugs,post-transplant viral infections and hypomagnesemia.Oral hypoglycaemic agents are the first choice for the treatment of type 2 diabetes mellitus in non-transplanted patients.However,the evidence on the safety and efficacy of oral hypoglycaemic agents in transplant recipients is limited.The favourable risk/benefit ratio,which is suggested by large-scale and long-term studies on new glucoselowering drug classes such as glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors,makes studies warranted to assess the potential role of these agents in the management of PTDM.展开更多
Post-transplant diabetes mellitus(PTDM)increases the risk of graft failure and death in liver transplant(LT)recipients.Experimental studies have indicated that enteric dysbiosis mediated by immunosuppressive tacrolimu...Post-transplant diabetes mellitus(PTDM)increases the risk of graft failure and death in liver transplant(LT)recipients.Experimental studies have indicated that enteric dysbiosis mediated by immunosuppressive tacrolimus(TAC)could contribute to glucose disorders,but no data on human recipients with PTDM have been reported.Here,by combining high-throughput shotgun metagenomics sequencing and metabolomics profiling,we characterized the intestinal microbiome(IM)in LT recipient cohort with or without PTDM and deciphered the potential relationship among IM,TAC dosage,and diabetes.By comparing with both non-PTDM and classical type 2 diabetes mellitus(T2DM),we identified microbial signatures of PTDM,which was characterized by the enriched Proteobacteria and decreased Bacteroidetes.Additionally,the altered microbes,as well as the microbial metabolomics,correlated with the dosage of TAC.Specifically,the levels of beneficial microbes associated with PTDM were lowered in recipients with the high TAC trough concentrations(>5 ng·mL^(-1))than those with low ones(<5 ng·mL^(-1)),which was accompanied by reduced faecal metabolites involved in the biosynthesis of a-linolenic acid and arachidonic acid-lowering factors of developing T2DM.Moreover,these microbial signatures linked with the extent of glucose disorders in LT recipients.In summary,the faecal microbiome and metabolome differed between PTDM and non-PTDM patients,which were linked with TAC dosage.This study was the first to explore taxonomic alterations and bacterial gene functions to better understand the contribution of the IM to PTDM.展开更多
Objective:To systematically evaluate the main risk factors of post-transplant diabetes mellitus(PTDM)after renal transplantation in China in the past 10 years.Methods:CNKI,Wanfang,VIP,and PubMed were searched to colle...Objective:To systematically evaluate the main risk factors of post-transplant diabetes mellitus(PTDM)after renal transplantation in China in the past 10 years.Methods:CNKI,Wanfang,VIP,and PubMed were searched to collect the related literatures on risk factors of PTDM after renal transplantation published by Chinese scholars from January 2010 to October 2020.The data were extracted and Meta-analysis was performed by Revman 5.3 software.Results:A total of 18 case-control studies were included,involving 5458 patients.There were 1106 PTDM cases after kidney transplantation and 4352 cases without PTDM after kidney transplantation.Meta-analysis results showed age[MD=6.09,P<0.00001],gender[OR=1.22,P=0.02],family history of diabetes[OR=5.56,P<0.0001],source of donor kidney[OR=1.87,P<0.0001],BMI[MD=1.76,P<0.00001],HBV infection[OR=2.52,P=0.04],HCV infection[OR=2.55,P<0.0001],CMV infection[OR=1.81,P=0.008],Cyclosporin A[OR=0.51,P=0.04],tacrolimus[OR=2.34,P=0.003],acute rejection[OR=2.72,P<0.00001],and smoking history[OR=2.01,P=0.0006]were associated with PTDM after renal transplantation in China.Conclusion:Age,gender,family history of diabetes,source of kidney donors,BMI,HBV,HCV,CMV,tacrolimus,acute rejection,and smoking history are risk factors for PTDM after kidney transplantation in China.Cyclosporin A is protective factors of PTDM after kidney transplantation in China.These factors are worthy of attention by relevant clinical workers in our country.展开更多
Sodium-glucose cotransporter-2 inhibitors(SGLT2i)are novel oral hypoglycemic agents garnering much attention for their substantial benefits.These recent data have positioned SGLT2i at the forefront of diabetic chronic...Sodium-glucose cotransporter-2 inhibitors(SGLT2i)are novel oral hypoglycemic agents garnering much attention for their substantial benefits.These recent data have positioned SGLT2i at the forefront of diabetic chronic kidney disease(CKD)and heart failure management.SGLT2i use post-kidney transplant is an emerging area of research.Highlights from this mini review include the following:Empagliflozin is the most prescribed SGLT2i in kidney transplant recipients(KTRs),median time from transplant to initiation was 3 years(range:0.88-9.6 years).Median baseline estimated glomerular filtration rate(eGFR)was 66.7 mL/min/1.73 m2(range:50.4-75.8).Median glycohemoglobin(HgbA1c)at initiation was 7.7%(range:6.9-9.3).SGLT2i were demonstrated to be effective short-term impacting HgbA1c,eGFR,hemoglobin/hematocrit,serum uric acid,and serum magnesium levels.They are shown to be safe in KTRs with low rates of infections,hypoglycemia,euglycemic diabetic ketoacidosis,and stable tacrolimus levels.More data is needed to demonstrate long-term outcomes.SGLT2i appear to be safe,effective medications for select KTRs.Our present literature,though limited,is founded on precedent robust research in CKD patients with diabetes.Concurrent research/utilization of SGLT2i is vital to not only identify long-term patient,graft and cardiovascular outcomes of these agents,but also to augment management in KTRs.展开更多
文摘BACKGROUND Solid organ transplantation is a life-saving intervention for end-stage organ disease.Post-transplant diabetes mellitus(PTDM)is a common complication in solid organ transplant recipients,and significantly compromises long-term survival beyond a year.AIM To perform a systematic review and meta-analysis to estimate incidence of PTDM and compare the effects of the 3 major immunosuppressants on incidence of PTDM.METHODS Two hundred and six eligible studies identified 75595 patients on Tacrolimus,51242 on Cyclosporine and 3020 on Sirolimus.Random effects meta-analyses was used to calculate incidence.RESULTS Network meta-analysis estimated the overall risk of developing PTDM was higher with tacrolimus(OR=1.495%CI:1.0–2.0)and sirolimus(OR=1.8;95%CI:1.5–2.2)than with Cyclosporine.The overall incidence of PTDM at years 2-3 was 17%for kidney,19%for liver and 22%for heart.The risk factors for PTDM most frequently identified in the primary studies were age,body mass index,hepatitis C,and African American descent.CONCLUSION Tacrolimus tends to exhibit higher diabetogenicity in the short-term(2-3 years post-transplant),whereas sirolimus exhibits higher diabetogenicity in the longterm(5-10 years post-transplant).This study will aid clinicians in recognition of risk factors for PTDM and encourage careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.
文摘A common challenge in managing kidney transplant recipients(KTR)is posttransplant diabetes mellitus(PTDM)or diabetes mellitus(DM)newly diagnosed after transplantation,in addition to known pre-existing DM.PTDM is an important risk factor for post-transplant cardiovascular(CV)disease,which adversely affects patient survival and quality of life.CV disease in KTR may manifest as ischemic heart disease,heart failure,and/or left ventricular hypertrophy.Available therapies for PTDM include most agents currently used to treat type 2 diabetes.More recently,the use of sodium glucose co-transporter 2 inhibitors(SGLT2i),glucagon-like peptide-1 receptor agonists(GLP-1 RA),and dipeptidyl peptidase 4 inhibitors(DPP4i)has cautiously extended to KTR with PTDM,even though KTR are typically excluded from large general population clinical trials.Initial evidence from observational studies seems to indicate that SGLT2i,GLP-1 RA,and DPP4i may be safe and effective for glycemic control in KTR,but their benefit in reducing CV events in this otherwise high-risk population remains unproven.These newer drugs must still be used with care due to the increased propensity of KTR for intravascular volume depletion and acute kidney injury due to diarrhea and their single-kidney status,pre-existing burden of peripheral vascular disease,urinary tract infections due to immunosuppression and a surgically altered urinary tract,erythrocytosis from calcineurin inhibitors,and reduced kidney function from acute or chronic rejection.
文摘目的分析妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清脂肪因子及一般生化指标水平的异常变化,研究其联合监测对GDM的临床意义。方法纳入该院GDM孕妇50例,正常孕妇50例,正常健康对照组50例,对孕妇组进行孕中期和孕晚期空腹血糖、空腹胰岛素(insulin,ins)、血清胆固醇(cholesterol,CHOL)、三酰甘油(triglyceride,TG)、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、甘丙肽(galanin,GAL)、脂联素(adiponectin,APN)的水平监测,同时监测正常对照组相关指标。结果孕中期,正常对照组GAL水平低于正常孕妇组,GDM组的空腹血糖、HOMA-IR、TG和GAL水平显著高于正常对照组。孕晚期,正常对照组血清HDL、LDL、GAL水平显著低于正常孕妇组,APN水平高于正常孕妇组,GDM组空腹INS、HOMA-IR、HDL和GAL水平显著高于正常对照组,APN水平明显低于正常对照组。孕中期GDM组空腹血糖、HOMA-IR、TG和GAL水平显著高于正常孕妇组,孕晚期空腹血糖和GAL水平差异具有统计学意义。孕中期GAL与空腹血糖、空腹ins、HOMA-IR、TG呈正相关,孕中期APN与空腹血糖、空腹ins、HOMA-IR、TG和LDL呈负相关。孕晚期GAL与空腹血糖、空腹ins、HOMA-IR、TG、LDL呈正相关,孕晚期APN与空腹血糖、空腹ins、HOMA-IR和LDL呈负相关。结论 GDM与血清脂肪因子水平呈密切相关,血清脂肪因子联合一般生化指标监测对GDM的发生和发展的预测和评估具有重要意义。
文摘Solid organ transplantation offers life-saving treatment for patients with endorgan dysfunction.Patient survival and quality of life have improved over the past few decades as a result of pharmacological development,expansion of the donor pool,technological advances and standardization of practices related to transplantation.Still,transplantation is associated with cardiovascular complications,of which post-transplant diabetes mellitus(PTDM)is one of the most important.PTDM increases mortality,which is best documented in patients who have received kidney and heart transplants.PTDM results from traditional risk factors seen in patients with type 2 diabetes mellitus,but also from specific posttransplant risk factors such as metabolic side effects of immunosuppressive drugs,post-transplant viral infections and hypomagnesemia.Oral hypoglycaemic agents are the first choice for the treatment of type 2 diabetes mellitus in non-transplanted patients.However,the evidence on the safety and efficacy of oral hypoglycaemic agents in transplant recipients is limited.The favourable risk/benefit ratio,which is suggested by large-scale and long-term studies on new glucoselowering drug classes such as glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors,makes studies warranted to assess the potential role of these agents in the management of PTDM.
基金supported by the National Natural Science Foundation of China(82170668,82171757,and 82241215)the National Key Research and Development Program of China(2021YFA1301001)+2 种基金the Sino-German Center for Research Promotion(GZ1546)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M-5-045)the Research Project of Jinan Microecological Biomedicine Shandong Laboratory(JNL-2022040C and JNL-2023006C)。
文摘Post-transplant diabetes mellitus(PTDM)increases the risk of graft failure and death in liver transplant(LT)recipients.Experimental studies have indicated that enteric dysbiosis mediated by immunosuppressive tacrolimus(TAC)could contribute to glucose disorders,but no data on human recipients with PTDM have been reported.Here,by combining high-throughput shotgun metagenomics sequencing and metabolomics profiling,we characterized the intestinal microbiome(IM)in LT recipient cohort with or without PTDM and deciphered the potential relationship among IM,TAC dosage,and diabetes.By comparing with both non-PTDM and classical type 2 diabetes mellitus(T2DM),we identified microbial signatures of PTDM,which was characterized by the enriched Proteobacteria and decreased Bacteroidetes.Additionally,the altered microbes,as well as the microbial metabolomics,correlated with the dosage of TAC.Specifically,the levels of beneficial microbes associated with PTDM were lowered in recipients with the high TAC trough concentrations(>5 ng·mL^(-1))than those with low ones(<5 ng·mL^(-1)),which was accompanied by reduced faecal metabolites involved in the biosynthesis of a-linolenic acid and arachidonic acid-lowering factors of developing T2DM.Moreover,these microbial signatures linked with the extent of glucose disorders in LT recipients.In summary,the faecal microbiome and metabolome differed between PTDM and non-PTDM patients,which were linked with TAC dosage.This study was the first to explore taxonomic alterations and bacterial gene functions to better understand the contribution of the IM to PTDM.
基金Graduate Education Innovation Project of Shanxi Province in 2020(No.2020SY256)。
文摘Objective:To systematically evaluate the main risk factors of post-transplant diabetes mellitus(PTDM)after renal transplantation in China in the past 10 years.Methods:CNKI,Wanfang,VIP,and PubMed were searched to collect the related literatures on risk factors of PTDM after renal transplantation published by Chinese scholars from January 2010 to October 2020.The data were extracted and Meta-analysis was performed by Revman 5.3 software.Results:A total of 18 case-control studies were included,involving 5458 patients.There were 1106 PTDM cases after kidney transplantation and 4352 cases without PTDM after kidney transplantation.Meta-analysis results showed age[MD=6.09,P<0.00001],gender[OR=1.22,P=0.02],family history of diabetes[OR=5.56,P<0.0001],source of donor kidney[OR=1.87,P<0.0001],BMI[MD=1.76,P<0.00001],HBV infection[OR=2.52,P=0.04],HCV infection[OR=2.55,P<0.0001],CMV infection[OR=1.81,P=0.008],Cyclosporin A[OR=0.51,P=0.04],tacrolimus[OR=2.34,P=0.003],acute rejection[OR=2.72,P<0.00001],and smoking history[OR=2.01,P=0.0006]were associated with PTDM after renal transplantation in China.Conclusion:Age,gender,family history of diabetes,source of kidney donors,BMI,HBV,HCV,CMV,tacrolimus,acute rejection,and smoking history are risk factors for PTDM after kidney transplantation in China.Cyclosporin A is protective factors of PTDM after kidney transplantation in China.These factors are worthy of attention by relevant clinical workers in our country.
文摘Sodium-glucose cotransporter-2 inhibitors(SGLT2i)are novel oral hypoglycemic agents garnering much attention for their substantial benefits.These recent data have positioned SGLT2i at the forefront of diabetic chronic kidney disease(CKD)and heart failure management.SGLT2i use post-kidney transplant is an emerging area of research.Highlights from this mini review include the following:Empagliflozin is the most prescribed SGLT2i in kidney transplant recipients(KTRs),median time from transplant to initiation was 3 years(range:0.88-9.6 years).Median baseline estimated glomerular filtration rate(eGFR)was 66.7 mL/min/1.73 m2(range:50.4-75.8).Median glycohemoglobin(HgbA1c)at initiation was 7.7%(range:6.9-9.3).SGLT2i were demonstrated to be effective short-term impacting HgbA1c,eGFR,hemoglobin/hematocrit,serum uric acid,and serum magnesium levels.They are shown to be safe in KTRs with low rates of infections,hypoglycemia,euglycemic diabetic ketoacidosis,and stable tacrolimus levels.More data is needed to demonstrate long-term outcomes.SGLT2i appear to be safe,effective medications for select KTRs.Our present literature,though limited,is founded on precedent robust research in CKD patients with diabetes.Concurrent research/utilization of SGLT2i is vital to not only identify long-term patient,graft and cardiovascular outcomes of these agents,but also to augment management in KTRs.
