A research team at Vienna General Hospital’s University Department of Internal Medicine III has found that preemptive insulin therapy drastically lowers the risk of patients developing diabetes mellitus, or Type 2 diabetes, after a kidney transplant. As of now, up to 30 percent of patients receiving kidney transplants develop diabetes within a year of the transplant.
“We give the patients insulin immediately after the transplant even before diabetes mellitus occurs,” says Marcus Säemann of the Clinical Department of Nephrology and Dialysis. “The new thing about this is that we are giving insulin to non-diabetics and are hereby treating patients preventatively.”
The research group has proven this approach to be successful. A selection of 25 patients who were treated with preventative insulin therapy for three months after the transplant showed about a 75% decrease in their chances of developing diabetes. A control group that was not administered insulin treatment but treated according to the current standards for kidney transplant patients had a 45% chance of developing diabetes within the year following the transplant. “This is sensational data that we have obtained from thousands of blood sugar measurements,” said Manfred Hecking, a supervisor for the study.
The research team’s efforts did not go unnoticed. Their initial results caught the attention of the University of Michigan as a research partner. Starting at the end of 2011 the United States National Institutes of Health (NIH) will sponsor the study and expand upon it across multiple research facilities throughout the world. The study will last three to five years and will be coordinated by Hecking and Säemann. Research facilities in Germany, France, Italy and Spain will contribute to the effort.
Kidney transplant patients often develop diabetes mellitus in the year following the transplant because of increased stress from the surgery and also from the high levels of immunosuppressant drugs given to the patient to prevent acute organ rejection. “The patient shall be, so to say, swept away from a wave of acute disease,” says Säemann. There are currently no effective treatments in use for the development of diabetes following a transplant. Diabetes drastically shortens the patient’s life expectancy and quality of life in addition to reducing the lifespan of the transplant organ. The results of this new study provide hope for those waiting on kidney transplants that they may not have to face diabetes in their lifetimes.
Kidney transplants typically extend the life of patients by 10-15 years. Even elderly patients who receive transplants live four more years on average than if they had stayed on dialysis. Patients who receive kidney transplants see their quality of life improve greatly. They feel less fatigued and can eat a less restrictive diet.
Kidney transplant patients must take a variety of immunosuppressant medications to prevent the body from rejecting the new kidney. The most common combination of medications includes tacrolimus, mycophenolate, and prednisone; patients have to take these expensive medications for the remainder of their lives. Amid the chances of organ rejection and development of diabetes, kidney transplant patients are also at risk of infections and sepsis, lymphoma, hair loss, acne, obesity, and raised cholesterol. Preventative insulin therapy may one day eliminate the development of Type 2 diabetes as a risk that kidney transplant patients must take.
“Our study is a great advance for transplant medicine generally,” said Säemann. The Vienna General Hospital currently treats about 1,100 patients who received kidney transplants with outpatient therapy.