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Table 2—

Different aspects of the management of transplant recipients with new-onset diabetes and differences from management of patients with diabetes in the general population

Management aspectRecommendation/frequency of testingComments/similarity with general management of type 2 diabetes
FPG testing • Weekly for first month posttransplant • Used to identify patients with abnormal glucose regulation 
 • At 3, 6, and 12 months  
 • Annually after the first year  
OGTT testing • Consider for patients with normal FPG or those with IGT • Utility of test not validated in this population 
   
Tailoring immunosup-pressive therapy   
 • Decrease corticosteroids as soon as possible • Complete withdrawal of corticosteroids not recommended due to risk of acute rejection 
 • Consider switch to cyclosporine in poorly controlled tacrolimus-treated patients  
Self-monitoring of blood glucose   
 • Essential component of management for patients receiving oral agents/insulin • Similar to recommendation for patients with type 2 diabetes 
 • Useful for patients on nonpharmacologic therapy  
Lipid levels • Evaluate annually • Similar to recommendation for patients with type 2 diabetes 
A1C • Measure every 3 months; intervention for A1C ≥6.5% • Same target as IDF and ACE 
  • Interpret test with care in patients with anemia/kidney impairment 
Diabetic complications • Screen annually • Similar to recommendation for patients with type 2 diabetes 
Microalbuminuria • Consider annual screening • Not validated in this population 
Oral agent monotherapy • Make choice of agent mainly on safety • Comparative efficacy of agents not investigated in this population 
 • Consider possibility of serious adverse events in patients with kidney impairment  
Combination therapy • Use same combinations as used for patients with type 2 diabetes • No combinations tested in this patient population 
Insulin + oral agents • Consider for patients poorly controlled with com-bination therapy • Not tested in this patient population 
Dyslipidemia • Aggressive lipid-lowering as detailed by NCEP • All patients considered at high risk of CHD 
Hypertension • Reduction of blood pressure <130/80 mmHg • Same target recommended by ADA 
  • Value of blood pressure lowering not tested in this population 
Management aspectRecommendation/frequency of testingComments/similarity with general management of type 2 diabetes
FPG testing • Weekly for first month posttransplant • Used to identify patients with abnormal glucose regulation 
 • At 3, 6, and 12 months  
 • Annually after the first year  
OGTT testing • Consider for patients with normal FPG or those with IGT • Utility of test not validated in this population 
   
Tailoring immunosup-pressive therapy   
 • Decrease corticosteroids as soon as possible • Complete withdrawal of corticosteroids not recommended due to risk of acute rejection 
 • Consider switch to cyclosporine in poorly controlled tacrolimus-treated patients  
Self-monitoring of blood glucose   
 • Essential component of management for patients receiving oral agents/insulin • Similar to recommendation for patients with type 2 diabetes 
 • Useful for patients on nonpharmacologic therapy  
Lipid levels • Evaluate annually • Similar to recommendation for patients with type 2 diabetes 
A1C • Measure every 3 months; intervention for A1C ≥6.5% • Same target as IDF and ACE 
  • Interpret test with care in patients with anemia/kidney impairment 
Diabetic complications • Screen annually • Similar to recommendation for patients with type 2 diabetes 
Microalbuminuria • Consider annual screening • Not validated in this population 
Oral agent monotherapy • Make choice of agent mainly on safety • Comparative efficacy of agents not investigated in this population 
 • Consider possibility of serious adverse events in patients with kidney impairment  
Combination therapy • Use same combinations as used for patients with type 2 diabetes • No combinations tested in this patient population 
Insulin + oral agents • Consider for patients poorly controlled with com-bination therapy • Not tested in this patient population 
Dyslipidemia • Aggressive lipid-lowering as detailed by NCEP • All patients considered at high risk of CHD 
Hypertension • Reduction of blood pressure <130/80 mmHg • Same target recommended by ADA 
  • Value of blood pressure lowering not tested in this population 

CHD, coronary heart disease; NCEP, National Cholesterol Education Program.

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