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Acta clinica Croatica, Vol. 60. No. Supplement 1, 2021.

Original scientific paper

https://doi.org/10.20471/acc.2021.60.s1.13

New-Onset Diabetes after Kidney Transplantation: Diagnosis, Risk Factors, and Management

Tomislav Bulum orcid id orcid.org/0000-0003-4808-2968 ; Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; Medical School, University of Zagreb, Zagreb, Croatia
Ingrid Prkačin orcid id orcid.org/0000-0002-5830-7131 ; Medical School, University of Zagreb, Zagreb, Croatia; Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
Lea Duvnjak ; Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; Medical School, University of Zagreb, Zagreb, Croatia

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Abstract

New-onset diabetes after transplantation (NODAT) is a frequent and severe complication
after renal transplantation. It is diagnosed according to standard criteria for type 2 diabetes.
Risk factors for NODAT are non-modifiable (non-white ethnicity, older age, genetic predisposition,
previous glucose intolerance, steroid therapy, male donor, and others) and modifiable (obesity, viral
infections, and immunosuppressive therapy). Glucose control is needed immediately after renal transplantation
and after 3, 6, and 12 months and annual glucose control is needed after that period. When
NODAT is diagnosed, the primary goal includes lifestyle modification, like a diet with weight loss
and exercise, and obtaining optimal glucose control to reduce micro- and macrovascular complications
of diabetes. In order to obtain better glucose control, modification of immunosuppressant therapy is
also needed, like a reduction of corticosteroid and calcineurin inhibitors and also a conversion of tacrolimus
to a less glucotoxic agent. Pharmacotherapy includes oral hypoglycemic agents (in most
cases metformin, sulfonylureas, and dipeptidyl peptidase-4 (DPP-4) inhibitors) and insulin (in most
cases biphasic insulin several times daily or intensive insulin therapy). Finally, metabolic risk factors
like dyslipidemia and hypertension should also be treated, and a regular annual screening should be
performed for micro- and macrovascular complications of diabetes.

Keywords

New-onset diabetes after transplantation (NODAT); Immunosuppressive drugs; Diabetes management; Kidney

Hrčak ID:

260407

URI

https://hrcak.srce.hr/260407

Publication date:

1.1.2021.

Article data in other languages: croatian

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