The incidence of new-onset diabetes after transplant (NODAT) varies depending on the organ transplanted and the underlying disease, and in about 80% of cases it develops within three months after surgery. The disease is associated with an increased risk of organ rejection, infections, cardiovascular events and death. The need for immunosuppressive drugs such as glucocorticoids and calcineurin inhibitors is an important risk factor for the development of NODAT. Thorough pre-transplant screening is essential for the correct management of NODAT, and patients who develop diabetes mellitus (DM) must receive appropriate educational therapy. The stress of surgery and high doses of glucocorticoids in the immediate post-transplant period make insulin necessary from the early days in the majority of cases, but since no specific studies are available for the long-term management of NODAT the ADA guidelines for the treatment of type 2 DM are applied. When educational therapy fails to control glucose homeostasis, insulin is the most effective and safest drug for these patients. Metformin is not recommended as first-line drug for NODAT, but transplant is not an absolute contraindication to its use which, however, must be closely supervised. Studies to assess the efficacy and safety of incretins for patients with NODAT are currently in progress, but these drugs can lead to reduced intestinal motility, which could interfere with immunosuppressive therapy. Thiazolidinediones are not indicated in this population, predisposed to osteoporosis and at increased cardiovascular risk. Sulfonylureas are contraindicated too, particularly the molecules that can cause severe and prolonged hypoglycemia. In conclusion, when educational therapy fails to control NODAT adequately, the use of antidiabetic drugs - except insulin - is still under discussion, since no randomized controlled trials on their use in this population have been reported.
|Number of pages||5|
|Journal||Giornale Italiano di Diabetologia e Metabolismo|
|Publication status||Published - 2012|
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism