Post-
transplantation diabetes mellitus (PTDM), also known as new-onset
diabetes mellitus (NODM), occurs in 10-15% of renal transplant recipients and is associated with
cardiovascular disease and reduced lifespan. In the majority of cases, PTDM is characterized by β-cell dysfunction, as well as reduced
insulin sensitivity in liver, muscle and adipose tissue.
Glucose-lowering
therapy must be compatible with
immunosuppressant agents, reduced glomerular filtration rate (GFR) and severe
arteriosclerosis. Such
therapy should not place the patient at risk by inducing hypoglycaemic episodes or exacerbating renal function owing to adverse gastrointestinal effects with hypovolaemia. First-generation and second-generation sulphonylureas are generally avoided, and caution is currently advocated for the use of
metformin in patients with GFR <60 ml/min/1.73 m(2).
DPP-4 inhibitors do not interact with
immunosuppressant drugs and have demonstrated safety in small clinical trials. Other therapeutic options include glinides and
glitazones. Evidence-based treatment regimens used in patients with
type 2 diabetes mellitus cannot be directly implemented in patients with PTDM. Studies investigating the latest drugs are required to direct the development of improved treatment strategies for patients with PTDM. This Review outlines the modern principles of
glucose-lowering treatment in PTDM with specific reference to renal transplant recipients.