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.