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New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines

An endocrinologist’s view

¹ Endocrine and Diabetes Associates of Texas, Dallas, Texas
² David Geffen School of Medicine at UCLA, Los Angeles, California

Address correspondence and reprint requests to Professor J.A. Davidson, Endocrine and Diabetes Associates of Texas, 7777 Forest Ln. B-445, Dallas, TX 75230. E-mail: jdavidson@medicalcitydallas.com

Abbreviations: ACE, American College of Endocrinology • CNI, calcineurin inhibitor • CVD, cardiovascular disease • FPG, fasting plasma glucose • IDF, International Diabetes Federation • IGT, impaired glucose tolerance • OGTT, oral glucose tolerance test

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
New-onset diabetes and impaired glucose tolerance (IGT) are among the most serious metabolic complications of solid organ transplantation. Despite the importance of these conditions to the outcome of transplant recipients, their precise incidence is difficult to determine. This is due to the fact that there has been, until recently, no consensus regarding the definition of new-onset diabetes after transplantation. Thus different studies described in the literature have used a variety of diagnostic criteria (1). Consequently, the reported incidence of new-onset diabetes after transplantation has varied between 2 and 53%, whereas the prevalence of diabetes in the general population is estimated at 4% (2,3).

Although new-onset diabetes has been recognized as a complication of transplantation for 50 years (4), the significance of the condition has been grossly underestimated. This is largely due to the fact that diabetes in transplant recipients was generally thought not to be associated with the micro- and macrovascular complications of diabetes in the nontransplant population (5). It is now clear, however, that the development of new-onset diabetes after transplantation is a major determinant of the increased cardiovascular morbidity and mortality seen in transplant recipients (6–8). Furthermore, studies indicate that the development of diabetes after transplantation has serious consequences for the patient, being associated with reduced graft function and patient survival and increased risk of graft loss (5,9,10). In addition, a recent analysis has revealed that the costs of developing new-onset diabetes after kidney transplantation are $12,000–$13,000 higher than for those with no diabetes by the end of the first year following transplantation. These costs rise to $19,000–$22,000 higher by the end of the second year (11).

Studies suggest that a number of risk factors exist . . . [Full Text of this Article]

	INCIDENCE OF NEW-ONSET DIABETES AFTER TRANSPLANTATION

 

	IMPACT OF NEW-ONSET DIABETES AFTER TRANSPLANTATION

 

	PREDICTIVE FACTORS FOR NEW-ONSET DIABETES AFTER TRANSPLANTATION

 

	SIMILARITIES BETWEEN NEW-ONSET DIABETES AND TYPE 2 DIABETES

 

	MANAGEMENT OF PATIENTS WITH NEW-ONSET DIABETES AFTER TRANSPLANTATION

 
Pretransplant management
Posttransplant management
Monitoring of the transplant recipient.
Management of the transplant recipient.
Dyslipidemia and hypertension.

	SUMMARY

 

	APPENDIX

 
^*Members of the International Expert Panel

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