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Post-transplantation diabetes is better controlled after conversion from prednisone to deflazacort: a prospective trial in renal transplants
Authors:Yu Seun Kim  Myoung Soo Kim  Soon Il Kim  Seung Kil Lim  Ho Yung Lee  Dae Suk Han  Kiil Park
Affiliation:(1) Department of Surgery, Severance Hospital, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul, Korea Fax: + 82 2 313 8289, KR;(2) Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul, Korea, KR
Abstract:It is well known that long-term use of steroids plays a decisive role in the development of glucose intolerance and diabetes mellitus (DM). Deflazacort, an oxazoline derivative of prednisolone, has been introduced as a potential substitute for conventional steroids in order to ameliorate glucose intolerance. We initiated a randomized study of conversion from prednisone to deflazacort in kidney transplantation (Tx) recipients presenting with pre-Tx or post-Tx DM to ascertain whether or not the switch to deflazacort would ameliorate the diabetic state. Forty-two recipients in the conversion group were compared with 40 patients on prednisone (the control group) in a prospective manner. The dose reduction of insulin or oral blood glucose-lowering agents, the adequacy of glucose control, and the development of side effects were the criteria for evaluating outcome. In the conversion group, patients were switched to deflazacort at a dose ratio of 6 mg deflazacort to 5 mg prednisone. During the mean follow-up period of 13.2 months, neither graft dysfunction nor acute rejection developed in the conversion group. Improvement in blood glucose control in the conversion group was noted. When the conversion group was stratified into pre- or post-Tx DM, promising effects were clearly evident in the post-Tx DM patients. More than 50 % dose reduction of blood glucose-lowering agents was possible in 42.3 % of post-Tx DM patients. In conclusion, it was readily possible to control blood glucose better in post-Tx DM recipients without seriously affecting the immunosuppressive activity after conversion to deflazacort. Received: 20 August 1996 Received after revision: 25 November 1996 Accepted: 6 December 1996
Keywords:Kidney transplantation  diabetes mellitus  deflazacort  Diabetes mellitus  kidney transplantation  deflazacort  Deflazacort  kidney transplantation  diabetes mellitus
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