Posttransplantation diabetes mellitus after liver transplant and the impact of family history of diabetes in a Mexican cohort

INTRODUCTION AND AIMS

Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD).

METHODS

A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM.

RESULTS

A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), p = 0.005) and 3.48 (95% CI 1.35-9.01, p = 0.010), when further controlled for pretransplant prediabetes.

CONCLUSION

The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.

[Risk factors for coronary heart disease in university students aged 17 to 19]

OBJECTIVE

To study the prevalence of risk factors for coronary heart disease (CHD) in university students between 17 an 19 years of age.

METHODS

A sample of 289 first year students, 144 females and 145 males, of the University of Costa Rica were included for anthropometric, biochemical and physical studies.

RESULTS

One in six (17% N = 48) had total cholesterol > 200 mg/dL and it was more frequent in females. High LDL-C > 130 mg/dL was found in 26% (N = 74) whereas low HDL-C was present in only 42% (N = 121). Nearly 10% (N = 28) smoked and 38% (N = 111) did not exercise. Obesity was seen in 7% (N = 20) when the Body Mass Index was used as a criterium but only 1.4% (N = 4) by body fat. The distribution of risk factors was: one factor in 36% (N = 105), two factors in 27% (N = 77) and three or more in 13% (N = 37). The most common were sedentarism, dislipedemias and smoking.

CONCLUSIONS

CHD risk factors were present in many of our adolescents. Our finding suggests the need to promote healthier lifestyles to minimize the potential of these factors to cause CHD in adulthood.