title: The diagnosis of posttransplantation diabetes mellitus: meeting the challenges.
abstract: Posttransplantation diabetes mellitus (PTDM) is a major complication after renal transplantation due to its negative impact on patient and graft survival, and affects up to 40% of renal transplant recipients. The generation of evidence regarding its optimal treatment is now progressing with some emphasis on early postoperative insulin treatment that targets β-cell failure. This therapy seems to benefit renal transplant patients but contrasts with previous PTDM guidelines that were following treatment of type 2 diabetes mellitus (DM): oral antidiabetics first, insulin last. Similarly, in the current PTDM consensus recommendations, diagnostic procedures are in accordance with the American Diabetes Association (ADA) recommendations for diagnosis of DM. PTDM and type 2 DM, however, are distinct disease entities with different pathophysiological backgrounds. This review will discuss the significance of the standard diagnostic criteria for DM in patients after renal transplantation without prior DM. In particular, the role of glycated hemoglobin (HbA1c) and oral glucose tolerance testing (OGTT) will be reviewed. In addition, the potential role of other glycated proteins and continuous glucose monitoring will be covered, although these parameters are not yet part of the consensus recommendations.
authors.affiliation: Department of Internal Medicine III, Section of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria, Johannes.werzowa@meduniwien.ac.at.
authors.forename: J
authors.initials: J
authors.lastname: Werzowa
authors.forename: M
authors.initials: M
authors.lastname: Hecking
authors.forename: M
authors.initials: M
authors.lastname: Haidinger
authors.forename: D
authors.initials: D
authors.lastname: Döller
authors.forename: A
authors.initials: A
authors.lastname: Sharif
authors.forename: A
authors.initials: A
authors.lastname: Tura
authors.forename: M D
authors.initials: MD
authors.lastname: Säemann
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D019270:Fructosamine / Q000378:metabolism; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*
chemical_list: D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin