High prevalence of diabetes before and after lung transplantation: target for improving outcome?

摘要

Abstract Background Diabetes increases morbidity and mortality of lung transplantation. However, the reported prevalence of diabetes varies post‐transplantation partly due to lack of detection protocols. Aim To determine the prevalence of diabetes in patients (i) waitlisted for lung transplant and (ii) early post‐transplantation. Methods We analysed patients on the St Vincent's Heart Lung database from 1 April 2014 to 30 September 2015 on the waitlist (Study 1) and those transplanted (Study 2). Standard of care required all non‐diabetic patients to have an oral glucose tolerance test (modified for patients with cystic fibrosis (CF) to screen for CF‐related hyperglycaemia (CFRH) (plasma glucose ≥8.2 mmol/L at 60 or 90 min). Results Study 1 included 114 patients (32 with CF and 82 without CF). Of 30 CF patients with glycaemic data, 27 (90%) had abnormal glucose metabolism: 18 had diabetes and nine had CFRH. In 50 patients without CF, 20 (40%) had abnormal glucose metabolism: eight had diabetes and 12 had impaired fasting glucose and/or impaired glucose tolerance. Study 2 included 78 transplanted patients (25 with CF and 53 without CF). Fourteen CF patients had pre‐existing diabetes and seven had pre‐existing CFRH. All but one patient were diagnosed with diabetes post‐transplantation. Hence, diabetes prevalence in CF patients post‐transplantation was 96%. Among 53 transplanted patients without CF, seven (13%) had abnormal glucose metabolism but 30 (57%) were diagnosed with post‐transplant diabetes. Conclusion There is a high prevalence of diabetes in lung transplant patients. Earlier endocrine participation in lung transplant services is likely to lower diabetes‐related morbidity and mortality further.