Reuters Health Information (2003-06-06): Guidelines issued to prevent and manage new-onset diabetes after transplant
Guidelines issued to prevent and manage new-onset diabetes after transplant
Last Updated: 2003-06-06 16:41:02 -0400 (Reuters Health)
NEW YORK (Reuters Health) - An international panel of experts has published the first consensus guidelines to reduce the risk, as well as diagnosis and manage, new-onset diabetes after organ transplantation. The new guidelines appear in a supplement to the May 27th issue of Transplantation.
According to panel co-chair Dr. Jaime Davidson, of the University of Texas Southwestern Medical School in the U.S., and associates, diabetes is a major complication of transplantation. One analysis Dr. Davidson and colleagues cite found that the type of immunosuppressive regimen after transplantation explains 74% of the variability in incidence.
Therefore, their guidelines emphasize the need to balance immunosuppressant efficacy with the agents' diabetogenicity, using treatment strategies based at least in part on each patient's risk factor profile.
"Steroid-sparing regimens should be considered to allow lower corticosteroid doses to be used," the guidelines state. They advocate switching from tacrolimus to cyclosporine if refractory diabetes develops.
The authors also discuss the factors associated with increased risk, which include black or Hispanic ethnicity, infection with hepatitis C, and receipt of a cadaveric kidney. They advise that patients be warned prior to transplantation that their appetite will probably increase after surgery and counseled as to appropriate diet, exercise and medication compliance.
Research shows that patients are initially at the greatest risk during the first 6 months after surgery, but the incidence continues to increase progressively over time. Hence, fasting plasma glucose levels should be measured at least weekly during the first month after transplantation, and then at 3, 6 and 12 months. Although annual monitoring is recommended after the first year, oral glucose tolerance testing should be considered if impaired glucose tolerance is diagnosed.
Noting that up to half of transplant recipients develop diabetes, Dr. Davidson told Reuters Health that "even if we can prevent only 20% of new-onset cases after transplantation, we will save millions of dollars" by initiating treatment early and preventing the complications associated with long-term hyperglycemia.
In his recent presentation at the American Transplant Meeting in Washington, DC, there was "overwhelming support for these guidelines," he added.