Posttransplantation diabetes mellitus A challenge for follow-up care

After solid organ transplantation 10-40% of patients will develop posttransplantation diabetes mellitus (PTDM). The main risk factors include age, overweight, pre-existing prediabetes and immunosuppression with calcineurin inhibitors and steroids. PTDM is associated with an elevated risk for cardiovascular mortality, presumably also with transplant failure and is therefore of significant importance for long-term survival of patients and graft survival. The gold standard for the diagnosis is the oral glucose tolerance test (OGTT), supported by fasting glucose, HbA1c and random glucose levels. Unlike type 2 diabetes, PTDM is treated in the reverse sequence. Directly after transplantation insulin therapy is preferred and in the further course treatment can often be deescalated and converted to an oral antidiabetic drug (OAD). With respect to the integration of OGTT, diabetes attitude, education and counselling on a healthy life style in the routine could meaningfully supplement the treatment chain with inpatient rehabilitation measures in specialized centers.