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New Onset Diabetes Mellitus in Patients Receiving Calcineurin Inhibitors: A Systematic Review and Meta-Analysis
Article first published online: 25 FEB 2004
DOI: 10.1046/j.1600-6143.2003.00372.x
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How to Cite
Heisel, O., Heisel, R., Balshaw, R. and Keown, P. (2004), New Onset Diabetes Mellitus in Patients Receiving Calcineurin Inhibitors: A Systematic Review and Meta-Analysis. American Journal of Transplantation, 4: 583–595. doi: 10.1046/j.1600-6143.2003.00372.x
Publication History
- Issue published online: 25 FEB 2004
- Article first published online: 25 FEB 2004
- Received 28 March 2003, revised and accepted for publication 19 November 2003
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Keywords:
- Cyclosporine;
- diabetes mellitus;
- heart;
- kidney;
- liver;
- lung;
- tacrolimus;
- transplantation
New onset diabetes mellitus (NODM) is a serious complication of transplantation. This meta-analysis evaluates the reported incidence of NODM after solid organ transplantation in patients receiving CNI treatment.
Databases from January 1992 to April 2002 were searched. Fifty-six publications providing NODM incidence data were reviewed. Sixteen prospective, randomized comparative studies providing information on incidence of insulin-dependent diabetes mellitus (IDDM) were subjected to meta-analysis.
New onset diabetes mellitus was reported in 13.4% of patients after solid organ transplantation, with a higher incidence in patients receiving tacrolimus than cyclosporine (16.6% vs. 9.8%). This trend was observed across renal, liver, heart and lung transplant groups. Meta-analysis of 16 studies included patients receiving either tacrolimus (n = 1636) or cyclosporine (n = 1407). The incidence of IDDM was significantly higher among tacrolimus-treated patients (10.4% vs. 4.5%, p < 0.00001), an effect observed in renal (9.8% vs. 2.7% p < 0.00001) and nonrenal (11.1% vs. 6.2%; p < 0.003) groups, and among patients receiving equal doses of concomitant medication in both treatment arms (12.0% vs. 3.0%; p < 0.00001).
The reported incidence of NODM during the past decade was significantly higher among patients receiving tacrolimus than cyclosporine. These data provide a quantitative foundation for studies designed to reduce the rates of NODM following solid organ transplantation.