*Purpose: One-third of dialysis patients will have spontaneous glycemic control improvement, necessitating discontinuation of antihyperglycemic therapy, termed diabetes burnout. The aim of this study was to evaluate healthcare utilization differences in patients based on the presence or absence of diabetes and diabetes burnout.

*Methods: This was a retrospective, longitudinal cohort study of adult patients who received a kidney transplant (tx) between 1/1/17 and 2/27/19. Multi-organ transplants were excluded. All patients received the same maintenance regimen of tacrolimus, mycophenolate mofetil and prednisone tapered to 5 mg at 1-month post-transplant. Patients were divided into three groups: control= no DM, group 1 = pre-tx treated DM or NODAT, and group 2=diabetes burnout. NODAT was defined as requiring oral or insulin therapy at 6 weeks post-transplant. Analyses for healthcare utilization were conducted using generalized linear mixed models and effect modification with DGF was assessed using interaction terms.

*Results: A total of 496 patients were evaluated. See Table 1 for baseline patient and tx characteristics. Patients in the control group were younger, more likely to be a repeat tx, and were working at the time of tx. eGFR at 1 months and 1 year were lower in group 1 and 2. Patient survival was lower in group 2 (p=0.02). DGF (HR 3.01 (CI 1.0166-8.893)) and age (HR 1.06 (CI 1-1.13)) were independent risk factors for patient survival. Patients with diet controlled diabetes were 2.5 times more likely to experience patient death, however this did not reach statistical significance in the adjusted model (CI 0.66-9.8).

*Conclusions: Particular attention should be payed to those patients with diet controlled diabetes prior to transplant, these data would suggest that they are at higher risk for suboptimal short and long-term patient and graft outcomes. Targeted interventions for diabetes throughout the transplant continuum are needed to ensure optimal long-term outcomes.

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