title: New-onset diabetes mellitus after kidney transplantation: Current status and future directions.
abstract: A diagnosis of new-onset diabetes after transplantation (NODAT) carries with it a threat to the renal allograft, as well as the same short- and long-term implications of type 2 diabetes seen in the general population. NODAT usually occurs early after transplantation, and is usually diagnosed according to general population guidelines. Non-modifiable risk factors for NODAT include advancing age, African American, Hispanic, or South Asian ethnicity, genetic background, a positive family history for diabetes mellitus, polycystic kidney disease, and previously diagnosed glucose intolerance. Modifiable risk factors for NODAT include obesity and the metabolic syndrome, hepatitis C virus and cytomegalovirus infection, corticosteroids, calcineurin inhibitor drugs (especially tacrolimus), and sirolimus. NODAT affects graft and patient survival, and increases the incidence of post-transplant cardiovascular disease. The incidence and impact of NODAT can be minimized through pre- and post-transplant screening to identify patients at higher risk, including by oral glucose tolerance tests, as well as multi-disciplinary care, lifestyle modification, and the use of modified immunosuppressive regimens coupled with glucose-lowering therapies including oral hypoglycemic agents and insulin. Since NODAT is a major cause of post-transplant morbidity and mortality, measures to reduce its incidence and impact have the potential to greatly improve overall transplant success.
authors.affiliation: Sneha Palepu, G V Ramesh Prasad, Division of Nephrology, University of Toronto, St. Michael's Hospital, Toronto ON M5C 2T2, Canada.
authors.forename: Sneha
authors.initials: S
authors.lastname: Palepu
authors.affiliation: Sneha Palepu, G V Ramesh Prasad, Division of Nephrology, University of Toronto, St. Michael's Hospital, Toronto ON M5C 2T2, Canada.
authors.forename: G V Ramesh
authors.initials: GV
authors.lastname: Prasad
keywords: Cyclosporine; Graft; Kidney; New-onset diabetes; Tacrolimus; Transplantation