Post-Transplant Diabetes: A Key Risk Factor for Kidney Transplant Recipients, study reveals

UK: A study published in Diabetic Medicine revealed that post-transplant diabetes frequently occurs in individuals undergoing solid organ transplants and increases the risk of mortality and morbidity among kidney transplant recipients.

Diabetes mellitus is a chronic metabolic disorder marked by hyperglycemia due to insulin deficiency, insulin resistance, or both. It precipitates significant complications, including cardiovascular diseases, neuropathy, nephropathy, and retinopathy, necessitating meticulous management through pharmacological interventions and lifestyle modifications.

Effective management includes regular monitoring of blood glucose levels, adherence to a balanced diet, physical activity, and medication or insulin therapy. Advances in diabetes research are continually improving treatment protocols and outcomes for individuals with this condition.

Diabetes is the leading cause of end-stage kidney disease worldwide, responsible for nearly 40% of new cases needing renal replacement therapy. Managing diabetes in individuals with advanced kidney disease on renal replacement therapy presents challenges due to unique aspects of their assessment and treatment.

Standard glycemic assessment using glycated hemoglobin may not be reliable in these patients because of altered red blood cell turnover or iron/erythropoietin deficiency, which affects red blood cell longevity. Therefore, continuous glucose monitoring can be advantageous for more precise glycemic assessment and better therapy adjustment.

Tahseen A Chowdhury, Department of Diabetes, The Royal London Hospital, London, UK et. al. conducted a study to evaluate diabetes management in people with advanced chronic kidney disease.

Individuals with advanced kidney disease are at a higher risk of hypoglycemia due to several physiological factors and therapeutic options are limited due to a lack of experience or licensing. Insulin therapy is the cornerstone of treatment for those with diabetes and advanced kidney disease since many other drug classes are contraindicated.

Glycemic control targets should be tailored based on co-morbidity and frailty, and continuous glucose monitoring should be used in dialysis patients to minimize the risk of hypoglycemia. 

Post-transplant diabetes is prevalent in solid organ transplant patients and significantly increases mortality and morbidity risks for kidney transplant recipients. Therefore, screening for and managing this condition in the post-transplant period is crucial to improve patient outcomes.

Reference

Chowdhury TA, Mukuba D, Casabar M, Byrne C, Yaqoob MM. Management of diabetes in people with advanced chronic kidney disease. Diabet Med. 2024 Jul 11:e15402. doi: 10.1111/dme.15402. Epub ahead of print. PMID: 38992927.