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Project 4
Project Title:
THERAPEUTIC CONTROL OF DIABETES IN LIVER TRANSPLANT PATIENTS
Lead Group: M. Berenguer Principal Investigator: M. Berenguer
COLLABORATING GROUPS: CIBEREHD Groups: De la Mata. National Groups not related to CIBEREHD: T. Serrano (Zaragoza), JI Herrero (Pamplona)
Post-liver transplant diabetes mellitus is associated with worse results, a higher rate of infections, rejection and mortality having been reported . To date, therapeutic compliance of diabetes in patients of this type has not been analysed in detail .
OBJECTIVES:
To describe the degree of control and care of diabetes in the liver transplant patients . A prospective, transverse and multicentre study has been conducted . The prevalence and factors associated with DM in 266 liver transplant recipients seen in external Hepatology consults in 4 centres in 2013 are analysed . The remaining parameters analysed are indicative of the degree of how much treatment for diabetes according to international standards is followed .
RESULTS:
The prevalence of diabetes mellitus was 50% (n=134) . No differences were observed in the rate of the following complications among diabetic patients and non-diabetic patients (n=132): high blood pressure (63% vs . 56%), renal failure chronic (14% vs . 18%) . In contrast, both hyperlipidemia (47% DM vs . 23% no-DM, p<0 . 01) and cardiovascular disease (20% vs . 8%, p=0 .03) were detected with a higher frequency in the group of patients with diabetes . 69% were overweight/obese (abdominal obesity of 85%) . In relation to follow-up and degree of compliance with diabetes, it was observed that in up to one third of all transplant patients (36%), screening was never conducted to rule out diabetes-related complications . In turn, levels of glycosylated haemoglobin showed unsuitable control in 33% of cases . Half the patients (53%) required insulin for treating diabetes . A small percentage of patients practiced moderate exercise (34%), whereas the majority followed a sedentary life or very gentle exercise (20% and 46%, respectively) . Although 63% followed a diabetic diet, 37% confessed to not controlling their diet . Less than half had received education on diabetes (37%) .
CONCLUSIONS:
• The prevalence of diabetes and of the typical associated co-morbidities are high in liver transplant recipients;
• Diabetes control is insufficient in this context with little control of the risk factors, inadequate screening of diabetes complications and poor glycaemic control;
• Treatment focuses on antidiabetic drugs, leaving aside other aspects with diet or the exercise;
• The role of the transplant team is important in diabetes follow-up but a multidisciplinary approach is necessary for better diabetes follow-up and control .
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