Treatment and monitoring post transplant diabetes mellitus in patients after kidney transplantation

Abstract

People who are a kidney transplant recipients are at high risk of developing diabetes (PTDM). This can lead to significant complications being a major cause of death. So early diagnosis and effective treatment are necessary to improve the prognosis and quality of patient’s live. After transplantation, an aggressive program should include life style intervention such as exercise training and reduce obesity to minimize the risk of PTDM. When diabetes develops, the dose of corticosteroids should be reduced as soon as possible. Any reduction in corticosteroid dose should be balanced against the possible increased risk of graft rejection. Transplant recipients who develop PTDM while receiving the tacrolimus may also benefit from a switch to the less diabetogenic agent cyclosporine. In patients with fasting blood glucose values of 130-180 mg/dl, the initial intervention is dietary restriction of concentrated sugars. Patients, who are refractory to dietary control or those with fasting blood glucose values of 181-250 mg/dl are usually started an oral hypoglycemic agents ( the choice of drugs should be made by the physician for each person ). People with fasting blood glucose values > 250 mg/dl or those who are unresponsive to oral hypoglycaemic agents need insulin. Good controlling of hypertension and hyperlipidaemia is also important. Use statins and ACE inhibitors is particularly helpful.
The prevention and treatment of PTDM is an important part of the care of people who undergo kidney transplantation.