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New-onset diabetes after kidney transplantation: diagnosis, risk factors, and management

After transplantation fasting plasma glucose should be tested at regular intervals at 0, 3, 6, and 12 months, and after that annually. If NODAT is diagnosed the goals of management strategies include lifestyle modification (weight control, diet, exercise), and regular blood glucose monitoring minimizing the short- and long-term complications of diabetes in order to preserve quality of life. Rapid corticosteroid reduction has the potential to reduce hyperglycemia as well as dose reduction of calcineurin inhibitors. Conversion of tacrolimus to cyclosporin or to mycophenolic acid or a target-of-rapamycin inhibitor can be also successful. Almost all oral hypoglycemic agent could be used: metformin (caution is required according to the level of renal function), sulfonylureas (risk of hypoglycemia and weight gain, increases cyclosporin level), thiazolidinediones (increases risk for heart failure and usually not used in renal transplant recipients), dipeptidyl peptidase-4 (DPP-4) inhibitors (shown to be safe and efficacious in renal transplant recipients), sodium-glucose cotransporter (SGLT) 2 inhibitors (increased risk of urinary and genital infections, usually not used in renal transplant recipients). Insulin therapy is safe and usually indicated in early post-transplant period when graft function is unstable or not yet established and when doses of immunosuppressant is high. Biphasic insulin (premix insulin) administered several times during day are usually used. If optimal glucose control is not achieved intensive insulin therapy is needed. NODAT is a frequent and serious complication after renal transplantation. Besides optimal glucose control treatment of other diabetes related metabolic disorders like hypertension and dyslipidemia is needed as well as annually screening for chronic complications of diabetes (retinopathy, nephropathy, neuropathy, peripheral arterial disease and cardiovascular disease) in order to preserve quality of life.

new-onset diabetes after kidney transplantation, diagnosis, risk factors

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