Renal posttransplantation diabetes mellitus: An overview

Abstract

We conducted a literature review about renal posttransplantation diabetes mellitus (PTDM), a glucose metabolism alteration with high incidence. Immunosuppressive therapy, by different diabetogenic mechanisms, is the major risk factor for PTDM. Although corticosteroids and calcineurin inhibitors are the drugs most related to PTDM, the mechanisms of other drugs have been also investigated. Available data in the literature show that, in renal transplant patients, the oral glucose tolerance test presents the highest diagnostic sensitivity for PTDM, although fasting plasma glucose is the most requested test. In addition, we also discussed the possible role of hemoglobin A1C in the diagnosis of PTDM. Renal PTDM is associated with patient survival reduction, increased cardiovascular mortality and has been linked to worsening graft function. As crucial as the screening, the accurate management of the disease can ameliorate graft and patient survival as well as the quality of life of this especial population. Several drugs have been studied in PTDM patients in order to achieve a better glycemic control and, in the best scenario, prevent PTDM. We present proper management approaches that should help to reduce the possible long-term consequences of PTDM.

Keywords: Diagnosis; Immunosuppressive therapy; Management; Posttransplantation diabetes mellitus; Renal transplantation.