Management of Post-Transplant Diabetes

New onset diabetes mellitus after transplant (NODAT) refers to the development of diabetes post-transplant in previously non-diabetic patients and is associated with increased rates of acute transplant rejection, infection, late cardiovascular events, and decreased survival. NODAT is primarily due to the immunosuppressive drug regimen but the standard predisposing risk factors for diabetes also pertain. NODAT is diagnosed by the standard ADA criteria, once prednisone doses are less than 10 mg per day and in the absence of acute illness. Sulfonylureas, metformin, DPP-4 inhibitors, GLP-1 agonists, and insulin can be used in treatment, but when there is impaired kidney or hepatic function, special precautions are necessary. In addition, those drugs interacting with P450 enzymes require additional consideration because of possible interaction with immunosuppressive drug metabolism.