Date

6-2015

Document Type

Thesis

Degree Name

M.S.

Institution

Oregon Health & Science University

Abstract

Background

New Onset Diabetes After Transplant (NODAT) is a complex disorder linked to risk factors such as obesity, post-transplant weight gain, and corticosteroid and immunosuppressive agents used after transplant. Non-pharmaceutical interventions that help patients maintain weight and glucose control are needed to lower the risk of developing NODAT.

Objectives

1. To determine the impact of nutrition education on post-surgical weight control in kidney transplant recipients who gain weight within two weeks of transplantation. 2. To determine the impact of nutrition education on post-surgical glycemic control in kidney transplant recipients with pre-existing Type 2 diabetes mellitus or who develop new-onset diabetes after transplantation.

Methods

We measured the effect of nutrition education on the maintenance of body weight and glycemic control in kidney transplant recipients (n=7) compared to propensity score-matched historical controls (n=14) who received kidney transplants at the same institution but did not receive nutrition education. Weight, immunosuppressant and diabetes treatment regimen, plasma creatinine concentrations, and glomerular filtration rate were measured before, at hospital discharge, and six and twelve weeks after transplant. Participant-centered nutrition education began with open-ended questions about the participants’ current diet, while incorporating how the nutrition education handout could be implemented for that patient, and completing the session with a patient generated S.M.A.R.T. goal. Nutrition education was based on The Plate Method promoted by the American Diabetes Association and was delivered two weeks after transplant surgery.

Results

The intervention group lost 0.89 ± 4.5 kg (p=0.66) from hospital admission to week 6 post-transplant and gained 3.4 ± 3.6 kg (p=0.03) from week 6 to week 12 post-transplant. The control group lost 1.1 ± 5.6 (p=0.43) from hospital admission to week 6 post-transplant and gained 3.6 ± 3.9 kg (p=0.002) from week 6 to week 12 post-transplant. Between hospital admission to week 6, there was a 0.24 kg (standard error 2.4, p=0.92) difference in post-transplant weight loss between the control and intervention groups. Between weeks 6 to 12, there was a 0.18 (standard error 1.7, p=0.92) difference in post-transplant weight gain between the control and intervention groups. Of the 7 participants enrolled in the intervention group, 4 participants who had type 2 diabetes mellitus (T2DM) prior to transplant and 1 participant was developed NODAT. From hospital admission to discharge, 2 participants with T2DM had a worsening and 2 participants had no change of diabetes treatment regimen; the participant who had NODAT had a worsening of diabetes treatment regimen. From discharge to week 6, 3 participants had a worsening and 1 participant had an improvement in diabetes treatment regimen; the participant who had NODAT had a worsening of diabetes treatment regimen. From week 6 to 12, 2 participants had no change and 2 participants had an improvement in diabetes treatment regimen; the participant who had NODAT had no change in diabetes treatment regimen. Whether a participant achieved his/her S.M.A.R.T. goal did not affect post-transplant weight maintenance or glycemic control.

Conclusions

1. Regardless of receiving nutrition education, kidney transplant recipients in both the control and intervention groups followed the same weight trajectory over the 12 week study period. 2. Participants who received nutrition education on glycemic control maintained or improved their diabetes treatment regimen by week 12. These results validate the need for early post-transplant interventions to assist recipients in maintaining blood glucose levels to decrease risk of cardiovascular and infection related death.

Identifier

doi:10.6083/M4NC5ZX3

Division

Graduate Programs in Human Nutrition

School

School of Medicine

Available for download on Sunday, June 17, 2018

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