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Cited by 24Diabetes Treatment and ManagementHyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and Research

Posttransplant diabetes mellitus: recent developments in pharmacological management of hyperglycemia

Munoz Pena, Juan M, Cusi, Kenneth·2023·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/clinem/dgad395
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Abstract

Context The management of solid-organ transplantation is rapidly evolving, and posttransplant diabetes mellitus (PTDM), which is increasingly common, is a barrier to transplant success, adversely impacting infection rates, allograft survival, cardiovascular disease, quality of life, and overall mortality. Currently, the management of PTDM relies primarily on intensified insulin therapy. However, emerging studies report that several noninsulin glucose-lowering agents are safe and effective in improving metabolic control and enhancing treatment adherence. More importantly, their use in PTDM can potentially transform the long-term management of these complex patients, as some glucose-lowering agents may provide benefits beyond glycemic control. For instance, glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors may offer cardiorenal protection, and pioglitazone may treat nonalcoholic fatty liver disease (NAFLD). This review will focus on the pharmacological management of PTDM and the emerging evidence for noninsulin glucose-lowering agents in this population. Evidence acquisition Evidence from observational studies, randomized controlled trials, and meta-analyses. Evidence synthesis PTDM adversely affects the outcomes of infection, organ survival, cardiovascular events, and mortality. Insulin therapy has been the drug of choice but is associated with weight gain and hypoglycemia. In contrast, noninsulin agents appear safe and…

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Crossref · 10.1210/clinem/dgad395

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  • Studies of metformin, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 RAs, and pioglitazone in individuals who have undergone kidney, heart, or liver transplantation have demonstrated effectiveness and safety.

    “Studies of metformin, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 RAs, and pioglitazone in individuals who have undergone kidney, heart, or liver transplantation have demonstrated effectiveness and safety but are limited by small sample sizes, short follow-up, and risk of bias due to retrospective or single-arm prospective designs (228).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [228]

  • Studies of metformin, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 RAs, and pioglitazone in transplant recipients are limited by small sample sizes, short follow-up, and risk of bias due to retrospective or single-arm prospective designs.

    “Studies of metformin, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 RAs, and pioglitazone in individuals who have undergone kidney, heart, or liver transplantation have demonstrated effectiveness and safety but are limited by small sample sizes, short follow-up, and risk of bias due to retrospective or single-arm prospective designs (228).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [228]

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Authors
Munoz Pena, J. M., & Cusi, K.
Affiliations
  • Division of Endocrinology, Diabetes & Metabolism, University of Florida , Gainesville, FL , USA
  • University of Florida Health (US)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2023-07-06
Volume
109
Issue
1
Pages
e1-e11
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/clinem/dgad395
OpenAlex
W4383483914
Cited by
24
References
23
Citations by year
2026: 4 · 2025: 14 · 2024: 6
FWCI
0.86
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
post-transplant diabetes mellitus, solid organ transplantation, hyperglycemia, insulin therapy, GLP-1 receptor agonists, SGLT2 inhibitors, pioglitazone, cardiorenal protection, non-alcoholic fatty liver disease, glycemic control, multidisciplinary care
MeSH terms
Pioglitazone, Diabetes Mellitus, Diabetes Mellitus, Type 2, Glucose, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Quality of Life, Glucagon-Like Peptide 1

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