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Review
. 2025 Jan 25;15(3):284.
doi: 10.3390/diagnostics15030284.

New Onset Diabetes After Organ Transplantation: Risk Factors, Treatment, and Consequences

Lucija Popović  1 , Tomislav Bulum  2   3
Affiliations
Review

New Onset Diabetes After Organ Transplantation: Risk Factors, Treatment, and Consequences

Lucija Popović et al. Diagnostics (Basel). .

Abstract

New onset diabetes mellitus after organ transplantation (NODAT) is a frequent and serious complication of solid organ transplantation. It significantly impacts graft function, patient survival, and quality of life. NODAT is diagnosed based on the criteria for type 2 diabetes, with the oral glucose tolerance test (OGTT) serving as the gold standard for diagnosis. The development of NODAT is influenced by a range of risk factors, which are classified into modifiable and non-modifiable categories. Post-transplant, regular glycemic monitoring at specific intervals is essential for timely diagnosis and initiation of therapy. Early intervention can help prevent or delay the onset of diabetes-related complications. The treatment strategy for NODAT involves lifestyle modifications and pharmacological interventions. These include medications such as metformin, sulfonylureas, glinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and insulin. Adjusting immunosuppressive therapy-either by reducing dosages or substituting drugs with lower diabetogenic potential-is a common preventative and therapeutic measure. However, this must be performed cautiously to avoid acute graft rejection, which poses a greater risk to the patient compared to NODAT itself. In addition to managing diabetes, addressing comorbidities such as hypertension and dyslipidemia is crucial, as they elevate the risk of cardiovascular events and mortality. Patients with NODAT are also prone to developing common diabetes-related complications, including diabetic nephropathy, neuropathy, retinopathy, and peripheral vascular disease. Therefore, regular follow-ups and appropriate treatment are vital to maintaining quality of life and improving long-term outcomes.

Keywords: diabetes; immunosuppressive medication; new onset diabetes after organ transplantation; risk factors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Monitoring glycemia before and after transplantation.
Figure 2
Figure 2
The diabetogenic effect of immunosuppressants (↑ increase, ↓ decrease; green arrows stimulate, red arrows suppress).
Figure 3
Figure 3
The impact of new onset diabetes after organ transplantation on organ and patient survival (↑ increase, ↓ decrease).
See this image and copyright information in PMC

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