New-onset diabetes mellitus (NODM)
NODM In the perspective of liver transplant:
New-onset diabetes mellitus (NODM) develops in approximately 15% of liver transplant cases (Heisel O et al 2004). NODM are associated with increased mortality and risk of infection. NODM occurs more frequently among patients with hepatitis C infection than others(Bigam DL et al 2000). Important risk factors include increasing weight, and alcoholic cirrhosis. (Baid S, Cosimi AB et al 2001.
Corticosteroid therapy, particularly bolus injections, increases likelihood of NODM.
Choice and dose of immunosuppressive agents is the major modifiable risk factor for NODM. A systematic review of studies of NODM in renal, liver, and heart transplantation found that the type of immunosuppressive regimen used accounted for 74% of variability in the cumulative incidence of NODM at 12 months after transplantation (Montori VM et al 2002). Patients undergoing liver transplantation should be screened for diabetes risk factors, and fasting plasma glucose should be monitored regularly in all transplant recipients. Management of NODM after live transplant is essentially similar to that of diabetes in the nontransplant population.
In addition to glucose control, effective control of raised blood pressure is very important to minimize the risk of short- and long-term diabetic complications; indeed the UK Prospective Diabetes Study study indicated that control of blood pressure is as important as glycemic control (UK Prospective Diabetes Study (UKPDS) Group 1998). Lowering of cholesterol levels is likely to be associated with reduced mortality, as has been demonstrated in nontransplant diabetic patients.(Huang ES et al 2001). Immunosuppression is the major modifiable risk factor for NODM, and individualizing the immunosuppression regimen in the light of a patient’s risk profile would seem a wise strategy.
REFERENCE :
(1)Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: A systematic review and meta-analysis. Am J Transplant 2004; 4: 583–595.
(2)Baid S, Cosimi AB, Farrell ML, Schoenfeld DA, Feng S, Chung RT, et al. Posttransplant diabetes mellitus in liver transplant recipients: Risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation 2001; 72: 1066–1072.
(3)Bigam DL, Pennington JJ, Carpentier A, Wanless IR, Hemming AW, Croxford R, et al. Hepatitis C-related cirrhosis: A predictor of diabetes after liver transplantation. Hepatology 2000; 32: 87–90.
(4) Montori VM, Velosa JA, Basu A, Gabriel SE, Erwin PJ, Kudva YC. Posttrasplantation diabetes: A systematic review of the literature. Diabetes Care 2002; 25: 583–592.
(5) Huang ES, Meigs JB, Singer DE. The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus. Am J Med 2001; 111: 633–642
(6) .(UK Prospective Diabetes Study (UKPDS) Group). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–853. - See more at: http://diabetescare24.com/new-onset-diabetes-mellitus-nodm/#sthash.fZ4JTsSb.dpuf
Risk of complications in patients with type 2 diabetes (UKPDS 33). See more at: Symptoms of Gestational Diabetes.
New-onset diabetes mellitus (NODM) develops in approximately 15% of liver transplant cases (Heisel O et al 2004). NODM are associated with increased mortality and risk of infection. NODM occurs more frequently among patients with hepatitis C infection than others(Bigam DL et al 2000). Important risk factors include increasing weight, and alcoholic cirrhosis. (Baid S, Cosimi AB et al 2001.
Corticosteroid therapy, particularly bolus injections, increases likelihood of NODM.
Choice and dose of immunosuppressive agents is the major modifiable risk factor for NODM. A systematic review of studies of NODM in renal, liver, and heart transplantation found that the type of immunosuppressive regimen used accounted for 74% of variability in the cumulative incidence of NODM at 12 months after transplantation (Montori VM et al 2002). Patients undergoing liver transplantation should be screened for diabetes risk factors, and fasting plasma glucose should be monitored regularly in all transplant recipients. Management of NODM after live transplant is essentially similar to that of diabetes in the nontransplant population.
In addition to glucose control, effective control of raised blood pressure is very important to minimize the risk of short- and long-term diabetic complications; indeed the UK Prospective Diabetes Study study indicated that control of blood pressure is as important as glycemic control (UK Prospective Diabetes Study (UKPDS) Group 1998). Lowering of cholesterol levels is likely to be associated with reduced mortality, as has been demonstrated in nontransplant diabetic patients.(Huang ES et al 2001). Immunosuppression is the major modifiable risk factor for NODM, and individualizing the immunosuppression regimen in the light of a patient’s risk profile would seem a wise strategy.
REFERENCE :
(1)Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: A systematic review and meta-analysis. Am J Transplant 2004; 4: 583–595.
(2)Baid S, Cosimi AB, Farrell ML, Schoenfeld DA, Feng S, Chung RT, et al. Posttransplant diabetes mellitus in liver transplant recipients: Risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation 2001; 72: 1066–1072.
(3)Bigam DL, Pennington JJ, Carpentier A, Wanless IR, Hemming AW, Croxford R, et al. Hepatitis C-related cirrhosis: A predictor of diabetes after liver transplantation. Hepatology 2000; 32: 87–90.
(4) Montori VM, Velosa JA, Basu A, Gabriel SE, Erwin PJ, Kudva YC. Posttrasplantation diabetes: A systematic review of the literature. Diabetes Care 2002; 25: 583–592.
(5) Huang ES, Meigs JB, Singer DE. The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus. Am J Med 2001; 111: 633–642
(6) .(UK Prospective Diabetes Study (UKPDS) Group). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–853. - See more at: http://diabetescare24.com/new-onset-diabetes-mellitus-nodm/#sthash.fZ4JTsSb.dpuf
Risk of complications in patients with type 2 diabetes (UKPDS 33). See more at: Symptoms of Gestational Diabetes.
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