Post-Transplant Diabetes Mellitus (PTDM)

What is Post-Transplant Diabetes Mellitus (PTDM)?

PTDM is the new onset of diabetes in patients who previously received an organ transplant. Specific predisposing factors play a role in the development of PTDM like:

          Age

          Body Mass Index (BMI)

          Hepatitis C virus (HCV) infection

          Various immunosuppressive therapies

          Ethnicity

Post-transplant diabetes mellitus (PTDM) is a complication which takes place after a solid organ transplant, and its incidence is widely variable, ranging from 2% to 53%. Specific types of immunosuppressive regimens (steroids) are related to the highest risk of for developing PTDM like, tacrolimus and corticosteroid. One of the major effects of the transplant is hyperglycemia.

Non-Modifiable Risk Factors:

          Ethnicity

          Age

          Gender of Recipient

          Donor’s Gender

          Family History of Diabetes

 

Modifiable Risk Factors Include:

          Immunosuppressive Therapy

o   Tacrolimus

o   Cyclosporine

o   Corticosteroid

o   Sirolimus

          Obesity

          Metabolic Syndrome

 

Potentially Modifiable Risk Factors:

          Infections

o   HCV

o   CMV

          Impaired Glucose Tolerance: IGT (pre-transplantation)

Every patient in the pre-transplant period must be examined for glucose intolerance and diabetes. The clinical history of the patient will also be important for the identification of risk factors and co-morbidities. The clinical management of patients with PTDM is normally the same as recommended for patients with type 2 diabetes (T2DM).

American Diabetes Association Guidelines

          A1C: 7%

          A1C may also be reported as eAG: 154 mg/dl

          Before a meal (preprandial plasma glucose): 70–130 mg/dl

          1-2 hours after beginning of the meal (Postprandial plasma glucose): Less than 180 mg/dl

          LDL Cholesterol: Less than 100 mg/dl

          HDL Cholesterol: Higher than 40 mg/dl for men and 50 mg/dl for women is good, but an HDL 50 mg/dl or higher helps everyone lower their risk for heart disease.

          Triglycerides: Less than 150 mg/dl

          Blood Pressure: 120/80

          Body Weight Control

Patients with PTDM have a higher risk of cardiovascular disease and infections compared to the general population and these problems could compromise the survival period and transplant durability. PTDM is a significant cause of morbidity in transplant patients. The early identification of this condition in addition to a thorough treatment of diabetes and its co morbidities will definitely determine its development.

ADA Glucose

ADA Cholesterol

ADA Blood Pressure

PTDM Journal Article

ptdm

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