Post Transplant Care Diabetes Treatment

Diabetes mellitus (PTDM) is a common side effect of solid organ transplantation. PTDM has been linked to higher mortality and infections in various transplant groups using various diagnostic criteria. Increased glucose monitoring throughout all hospitalizations revealed significant glucose intolerance in the majority of transplant recipients immediately after transplant. As a result, the international consensus panel revisited its previous recommendations and advised deferring PTDM screening and diagnosis until the recipient is on stable doses of immunosuppression after discharge from the initial transplant hospitalization. While hemoglobin A1C has been adopted as a diagnostic criterion by many, the group cautioned that it is not reliable as the sole diabetes screening method during the first year after transplant. Many immunosuppressive medications, as well as those used to treat type 2 diabetes, are risk factors for PTDM. The provider managing diabetes, dyslipidemia, and hypertension after transplant must be aware of the increased risk of drug-drug interactions and infections with immunosuppressive medications. Treatment objectives and therapies must take into account the increased risk of fluctuating and reduced kidney function, which can lead to hypoglycemia. While research is being conducted to develop strategies to prevent PTDM, it is critical that immunosuppression regimens be chosen based on their evidence to prolong graft survival rather than to avoid PTDM.

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