Diabetes mellitus: A major challenge in transplantation

In the general population, type 1 and type 2 diabetes are associated with an increased incidence of microvascular and macrovascular disease. Posttransplant diabetes mellitus is a leading disease among renal transplant recipients and increases the risk of graft loss and death after transplantation. PTDM is underdiagnosed. Published trials have inappropriately defined it as a requirement for insulin; this excludes patients with glucose intolerance and those with diabetes treated by oral agents who are also at increased risk of poorer outcomes. PTDM is associated with varying degrees of hyperglycemia and insulin deficiency. Most patients appear to develop a condition similar to type 2 diabetes, but in others PTDM is associated with severe hyperglycemia, ketoacidosis, and insulin dependence and more closely resembles type 1 diabetes. As is the case with diabetes in the general population, PTDM is associated with poor long-term graft and patient survival. Transplant patients are at increased risk of cardiovascular disease and PTDM is an independent factor that magnifies this risk.