The investigation of post-transplantation diabetes mellitus specificity and risk factors in solid organ transplantation in Başkent University Ankara Hospital

Post-transplant diabetes mellitus (PTDM) is a frequent consequence of solid organ transplantation. Post-Transplantation Diabetes Melitus(PTDM) adversely affects patients and allograft survival. Post-transplant diabetes has been associated with greater mortality and increased infections in different transplant groups using different diagnostic criteria. Post-transplant diabetes mellitus (PTDM) may be diagnosed at any time after transplantation based upon diagnostic criteria similar to those used in the nontransplant population by symptoms plus a random plasma glucose of ≥200 mg/dL (11.1 mmol/L), fasting plasma glucose of ≥126 mg/dL (7.0 mmol/L), or a two-hour plasma glucose of ≥200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT). All transplant recipients should have a fasting blood glucose measured weekly during the first four weeks posttransplant, then at three and six months posttransplant, and then yearly. A glycated hemoglobin (HbA1c) can be checked after three months posttransplant, particularly if it is difficult to obtain fasting plasma-glucose levels. Glucocorticoids, calcineurin inhibitors, and sirolimus increase the risk of PTDM. Compared with cyclosporine, tacrolimus is more diabetogenic. Azathioprine and mycophenolate mofetil (MMF) are not diabetogenic A stepwise approach is recommended for the management of PTDM, starting with nonpharmacologic therapy, followed by oral monotherapy, oral combination therapy, and finally insulin, providing metabolic decompensation has not occurred. Among most patients with PTDM, we initiate oral therapy with glipizide at a dose of 2.5 to 5 mg per day and then advance to 10 mg twice per day, as necessary, to maintain the HbA1c level at <7 percent. However, some experts would choose meglitinides such as repaglinide (Prandin) before sulfonylureas are used since sulfonylureas may have potential toxicity in the setting of renal dysfunction. Thiazolinediones are generally avoided among transplantation due to adverse side effects. We initiate insulin therapy if there has been metabolic decompensation, adverse side effects with oral therapy, or HbA1c levels that are consistently ≥7 percent. We may use multiple agents and/or multiple-dose intensive insulin therapy or insulin-pump therapy.