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Reviews/Commentaries/Position Statements

New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines

An endocrinologist’s view

  1. Jaime A Davidson, MD1,
  2. Alan Wilkinson, MD2 and
  3. on behalf of the International Expert Panel on New-Onset Diabetes after Transplantation*
  1. 1Endocrine and Diabetes Associates of Texas, Dallas, Texas
  2. 2David Geffen School of Medicine at UCLA, Los Angeles, California
  1. 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{at}medicalcitydallas.com
Diabetes Care 2004 Mar; 27(3): 805-812. https://doi.org/10.2337/diacare.27.3.805
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  • Figure 1—
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    Figure 1—

    Incidence of diabetes before and after transplantation in patients receiving tacrolimus (—) or cyclosporine (- - -). At 1 year posttransplant, the incidence of new-onset diabetes was significantly lower in patients receiving cyclosporine than in those receiving tacrolimus (14.1 vs. 22.9%; P < 0.0001). (From Woodward RS, Schnitzler MA, Baty J, et al.: Incidence and cost of new onset diabetes mellitus among U.S. waitlisted and transplanted renal allograft recipients. Am J Transplant 3:590–598, 2003, with permission from Blackwell Publishing Ltd.)

  • Figure 2—
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    Figure 2—

    Algorithm summarizing the recommended management for transplant recipients with new-onset diabetes. (From Davidson JA, Wilkinson A, Dantal J, et al.: New-onset diabetes after transplantation: 2003 international consensus guidelines. Transplantation 75:SS3–SS24, 2003, with permission from Lippincott Williams & Wilkins.)

Tables

  • Figures
  • Table 1—

    RR for ischemic heart disease among transplant recipients >1 year after kidney transplantation (8)

    Risk factorMen
    Women
    ControlTransplant recipientControlTransplant recipient
    Age (years)1.051.06*1.401.10
    Cholesterol (mg/dl)
     <1600.520.00†0.770.00†
     160–1991.00‡1.00‡1.00‡1.00‡
     200–2391.192.391.232.07
     240–2791.662.021.282.44
     >2801.932.251.711.84
    Blood pressure (mmHg)
     <120 and <801.000.250.590.56
     120–129 or 80–841.00‡1.00‡1.00‡1.00‡
     130–139 or 85–891.331.050.931.26
     140–159 or 90–991.681.191.301.63
     ≥160 or ≥1001.861.471.590.31
    Diabetes1.532.78*1.825.40*
    Smoking1.691.95*1.341.82
    • A RR of ≥1.00 indicates a higher or lower risk for ischemic heart disease, respectively. Control subjects are from the Framingham Heart Study.

    • *

      ↵* P < 0.05 compared with reference risk values for transplant recipients;

    • †

      ↵† too few patients were available to reliably assess this risk;

    • ‡

      ↵‡ reference risks for cholesterol levels and blood pressure are indicated by 1.00.

  • Table 2—

    Different aspects of the management of transplant recipients with new-onset diabetes and differences from management of patients with diabetes in the general population

    Management aspectRecommendation/frequency of testingComments/similarity with general management of type 2 diabetes
    FPG testing• Weekly for first month posttransplant• Used to identify patients with abnormal glucose regulation
    • At 3, 6, and 12 months
    • Annually after the first year
    OGTT testing• Consider for patients with normal FPG or those with IGT• Utility of test not validated in this population
    Tailoring immunosup-pressive therapy
    • Decrease corticosteroids as soon as possible• Complete withdrawal of corticosteroids not recommended due to risk of acute rejection
    • Consider switch to cyclosporine in poorly controlled tacrolimus-treated patients
    Self-monitoring of blood glucose
    • Essential component of management for patients receiving oral agents/insulin• Similar to recommendation for patients with type 2 diabetes
    • Useful for patients on nonpharmacologic therapy
    Lipid levels• Evaluate annually• Similar to recommendation for patients with type 2 diabetes
    A1C• Measure every 3 months; intervention for A1C ≥6.5%• Same target as IDF and ACE
    • Interpret test with care in patients with anemia/kidney impairment
    Diabetic complications• Screen annually• Similar to recommendation for patients with type 2 diabetes
    Microalbuminuria• Consider annual screening• Not validated in this population
    Oral agent monotherapy• Make choice of agent mainly on safety• Comparative efficacy of agents not investigated in this population
    • Consider possibility of serious adverse events in patients with kidney impairment
    Combination therapy• Use same combinations as used for patients with type 2 diabetes• No combinations tested in this patient population
    Insulin + oral agents• Consider for patients poorly controlled with com-bination therapy• Not tested in this patient population
    Dyslipidemia• Aggressive lipid-lowering as detailed by NCEP• All patients considered at high risk of CHD
    Hypertension• Reduction of blood pressure <130/80 mmHg• Same target recommended by ADA
    • Value of blood pressure lowering not tested in this population
    • CHD, coronary heart disease; NCEP, National Cholesterol Education Program.

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Diabetes Care: 27 (3)

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March 2004, 27(3)
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New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines
Jaime A Davidson, Alan Wilkinson
Diabetes Care Mar 2004, 27 (3) 805-812; DOI: 10.2337/diacare.27.3.805

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New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines
Jaime A Davidson, Alan Wilkinson
Diabetes Care Mar 2004, 27 (3) 805-812; DOI: 10.2337/diacare.27.3.805
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  • 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
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