Acta Diabetologica

, Volume 55, Issue 8, pp 763–779 | Cite as

Post-transplantation diabetes in kidney transplant recipients: an update on management and prevention

  • Caterina Conte
  • Antonio Secchi
Review Article


Post-transplantation diabetes mellitus (PTDM) may severely impact both short- and long-term outcomes of kidney transplant recipients in terms of graft and patient survival. However, PTDM often goes undiagnosed is underestimated or poorly managed. A diagnosis of PTDM should be delayed until the patient is on stable maintenance doses of immunosuppressive drugs, with stable kidney graft function and in the absence of acute infections. Risk factors for PTDM should be assessed during the pre-transplant evaluation period, in order to reduce the likelihood of developing diabetes. The oral glucose tolerance test is considered as the gold standard for diagnosing PTDM, whereas HbA1c is not reliable during the first months after transplantation. Glycaemic targets should be individualised, and comorbidities such as dyslipidaemia and hypertension should be treated with drugs that have the least possible impact on glucose metabolism, at doses that do not interact with immunosuppressants. While insulin is the preferred agent for treating inpatient hyperglycaemia in the immediate post-transplantation period, little evidence is available to guide therapeutic choices in the management of PTDM. Metformin and incretins may offer some advantage over other glucose-lowering agents, particularly with respect to risk of hypoglycaemia and weight gain. Tailoring immunosuppressive regimens may be of help, although maintenance of good kidney function should be prioritised over prevention/treatment of PTDM. The aim of this narrative review is to provide an overview of the available evidence on management and prevention of PTDM, with a focus on the available therapeutic options.


Kidney transplantation Insulin resistance Post-transplantation diabetes Hyperglycaemia Obesity 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard statement

No studies involving human participants nor experimental animals were conducted by the authors specifically for the preparation of this article.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.I.R.C.C.S. Ospedale San RaffaeleMilanItaly
  2. 2.Vita-Salute San Raffaele UniversityMilanItaly

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