Alvarez-Sotomayor Diego, Satorres Carla, Rodríguez-Medina Beatriz, Herrero Ignacio, de la Mata Manuel, Serrano Trinidad, Rodríguez-Perálvarez Manuel, DʼAvola Delia, Lorente Sara, Rubín Angel, Berenguer Marina
1 Hospital Universitario y Politécnico La Fe, Valencia, Spain.2 Hospitén Clínica Roca, Las Palmas, Spain.3 Clínica Universitaria de Navarra, Pamplona, Spain.4 Instituto de Investigación Sanitaria de Navarra (IdiSNA), CIBEREHD, Estella, Spain.5 Hospital Universitario Reina Sofía, CIBEREHD, Córdoba, Spain.6 Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain., Instituto de Investigación Sanitaria de Aragón, Zaraoza, Spain.7 Hospital Universitario y Politécnico La Fe, Universidad de Valencia, CIBEREHD, Valencia, Spain.
Transplantation. 2016 Oct;100(10):e66-e73. doi: 10.1097/TP.0000000000001399.
Diabetes mellitus is a chronic illness with great impact on long-term outcome after liver transplantation (LT). Despite this, the current level of glycemic control and quality of screening strategies for diabetes-associated conditions that are being provided to liver transplant recipients with diabetes have not yet been assessed.
We performed a cross-sectional, multicenter study that included 344 liver transplant recipients and examined the level of glycemic control and its associated factors, as well as the quality of screening strategies for diabetes-associated conditions.
Seventy-five patients (21.8%) suffered from diabetes before transplantation, and 82 (23.8%) developed diabetes mellitus after transplantation. Adequate glycemic control (HbA1c < 7%) was achieved in 66.7% of the patients. Forty-eight percent of patients underwent regular screening for retinopathy, 47.1% for nephropathy, 4.5% for neuropathy, and 5.7% for foot ulcers. Diabetes was associated with higher frequency of cardiovascular disease and dyslipidemia both before and after LT. Multivariate analysis revealed association between poor glycemic control and arterial hypertension, presence of diabetes before transplantation, elevated GGT, and insulin use.
Glycemic control was inadequate in 33.3% of LT recipients with diabetes, and screening protocols for diabetes-associated conditions did not meet the standards for medical care set by the American Diabetes Association in any of the participating centers. Consequently, this study reveals a clear deficiency in the quality of diabetes care provided to patients after LT and, hence, we predict that future progress in this area will have a significant impact on medium-term to long-term outcome of these patients.
糖尿病是一种慢性病，对肝移植（LT）后的长期预后有重大影响。尽管如此，目前为糖尿病肝移植受者提供的血糖控制水平以及糖尿病相关病症筛查策略的质量尚未得到评估。
我们开展了一项横断面多中心研究，纳入344例肝移植受者，考察血糖控制水平及其相关因素，以及糖尿病相关病症筛查策略的质量。
75例患者（21.8%）在移植前患有糖尿病，82例（23.8%）在移植后发生糖尿病。66.7%的患者实现了充分的血糖控制（糖化血红蛋白<7%）。48%的患者接受了视网膜病变的定期筛查，47.1%接受了肾病筛查，4.5%接受了神经病变筛查，5.7%接受了足部溃疡筛查。糖尿病在肝移植前后均与心血管疾病和血脂异常的较高发生率相关。多变量分析显示，血糖控制不佳与动脉高血压、移植前糖尿病的存在、γ-谷氨酰转移酶升高以及胰岛素使用之间存在关联。
33.3%的糖尿病肝移植受者血糖控制不佳，且在任何一个参与研究的中心，糖尿病相关病症的筛查方案均未达到美国糖尿病协会设定的医疗护理标准。因此，本研究揭示了肝移植后患者糖尿病护理质量存在明显不足，所以我们预计该领域未来的进展将对这些患者的中期至长期预后产生重大影响。
