Influence of lifestyle modification in renal transplant recipients with postprandial hyperglycemia

Lifestyle modification is recommended as first-line therapy to manage new-onset diabetes after transplantation (NODAT) and impaired glucose tolerance (IGT). No data currently demonstrate the efficacy of this approach specifically for transplant recipients. This study aimed to assess the benefit of intensive lifestyle modification in this high-risk group and to contrast this with the natural evolution of glucose metabolism after transplantation.

Baseline oral glucose tolerance test (OGTT) stratified 115 patients into two groups. Group 1 had glucose intolerance, IGT (n=28) and NODAT (n=8), and received intensive lifestyle modification (dietician referral, exercise program, weight loss advice). Group 2 had normal glucose tolerance (n=79) and received lifestyle modification leaflets. Both groups had follow-up OGTT after 6 months to assess change in glycemic status.

Excluding all patients who received steroid weaning or withdrawal as part of their management, 111 patients were included in the analysis. Lifestyle modification in group 1 resulted in 15% improvement in 2-hr postprandial glucose versus 12% deterioration in group 2. In group 1, 44% (n=11) of IGT patients developed normal glucose tolerance, whereas only 4% (n=1) developed NODAT. Fifty-eight percent (n=4) of NODAT patients showed improvement (29% to IGT and 29% to normal). Glucose metabolism deteriorated in group 2 with 14% (n=10) developing IGT and 3% (n=2) developing NODAT.

Glucose metabolism can deteriorate in transplant recipients despite passive lifestyle modification advice. This study shows active lifestyle modification benefits high-risk transplant recipients with glucose intolerance and should be aggressively pursued.