NEW-ONSET DIABETES AFTER TRANSPLANTATION: 2003 INTERNATIONAL CONSENSUS GUIDELINES1

Abstract

INTRODUCTION Diabetes Mellitus Diabetes mellitus is one of the most common chronic diseases in the world, with an estimated worldwide prevalence of over 176 million in 2000. Furthermore, the prevalence of the disease is expected to increase in the coming years as industrialized societies become older, more obese, and more sedentary, and it is predicted to rise to 370 million by 2030 (1). Acute metabolic complications of diabetes are associated with high mortality rates; in particular, hyperosmolar hyperglycemia (approximately 15%) and ketoacidosis (up to 5%). The prognosis in these conditions is substantially worse in older patients and those with coma or hypotension (2). Following a review of epidemiologic and pathologic evidence, the American Heart Association has also classified diabetes a major independent risk factor for cardiovascular disease (CVD) (3–8). Manifestations of CVD include atherosclerotic coronary heart disease (CHD), heart failure (diabetic cardiomyopathy), myocardial infarction, stroke, and peripheral vascular disease (7). The risk for stroke has been reported to be two to four times higher in patients with diabetes (7,9). Furthermore, patients with diabetes who develop CVD have a worse prognosis for survival than patients with CVD but without diabetes (8–11). In fact, CVD is listed as the cause of death in approximately 65% of patients with diabetes (12). In addition to the risk for macrovascular complications, diabetes is associated with long-term microvascular complications including neuropathy, retinopathy, nephropathy, and erectile dysfunction. Diabetic nephropathy is the most common single cause of end-stage renal disease in the United States and Europe (13). With respect to retinopathy, after 20 years with the condition, almost all individuals with type 1 diabetes and over 60% with type 2 diabetes have a degree of retinopathy that may progress to loss of vision (14). In fact, diabetes is now considered the leading cause of blindness in developed countries, causing 12,000 to 24,000 new cases each year (15,16). New-Onset Diabetes after Transplantation Diabetes and impaired glucose tolerance occurring as a complication of organ transplantation have been recognized for many years. However, incidence figures for new-onset diabetes after transplantation across different studies have ranged between 2% and 53% (17). Precise figures have been difficult to determine because there has been no consensus regarding the definition of the condition and hence different clinical studies have used a variety of diagnostic criteria. Despite the apparently high incidence of new-onset diabetes after transplantation, transplant patients are not always routinely screened for hyperglycemia posttransplant and the condition is often underestimated (18). Nevertheless, it is clear that development of diabetes after transplantation has serious consequences for the patient and threatens the outcome of transplantation; studies suggest that diabetes developing after transplantation is associated with reduced graft and patient and graft loss In addition to risk studies suggest that may for a degree of the risk for development of diabetes after transplantation However, used in the to diabetes and the of have a major risk for developing the In diabetes is a serious complication that the survival of the transplant long-term survival of the and the of is that and of patients and the risk for developing the Furthermore, and of patients who have developed diabetes the long-term consequences of the the of the the the the and the the New-Onset Diabetes after Transplantation is that of these may in or the incidence and of new-onset diabetes mellitus after The of New-Onset Diabetes after Transplantation Diabetes is one of the most serious long-term complications of transplantation, the condition is clinical suggest that transplant who develop diabetes are risk of complications, including graft graft and Furthermore, the chronic hyperglycemia associated with the condition a long-term risk of microvascular and macrovascular The development of new-onset diabetes also of in the United States between and has that the of developing new-onset diabetes after transplantation are between and higher than for those with no diabetes by the of the year and between and higher by the of the year and prevalence of new-onset diabetes after transplantation The prevalence of new-onset diabetes after transplantation has been underestimated in the because of the of a definition for the for diabetes after transplantation are glucose or glucose than and clinical not routinely include glucose tolerance to determine the incidence of in transplant has to in the reported incidence of the disease The of many studies are also are and the incidence of the risk of diabetes posttransplant and patients may develop the condition many years posttransplant The incidence of new-onset diabetes after transplantation in by incidence of diabetes after transplantatio