To consolidate the understanding of post-transplant diabetes mellitus (PTDM) pathogenesis, risk factors, diagnostic challenges, and management strategies, with a focus on integrating emerging research on gut microbiota.
Key Findings:
PTDM affects 7–39% of kidney transplant recipients and worsens cardiovascular, infectious, and allograft outcomes.
Immunosuppressive therapy, particularly calcineurin inhibitors and corticosteroids, significantly contributes to PTDM development.
Gut microbiota dysbiosis is proposed as a central mediator linking immunosuppression to metabolic dysfunction.
Risk factors include both non-modifiable (age, ethnicity, genetic factors) and modifiable (pre-transplant dysglycemia, obesity) determinants.
Diagnosis should rely on OGTT-centered assessment, with caution in interpreting HbA1c in early post-transplant periods.
Emerging therapies such as SGLT2 inhibitors and GLP-1 receptor agonists offer additional cardiometabolic benefits.
Interpretation:
PTDM is a complex, multi-hit syndrome influenced by immunological, metabolic, and microbial factors, necessitating a comprehensive and integrative approach to management.
Limitations:
The pathophysiology of PTDM is not fully understood.
Limited sensitivity of HbA1c as a diagnostic tool in the early post-transplant period.
Further research is needed on microbiome-targeted strategies.
Conclusion:
A unified framework for understanding PTDM can enhance prevention and management strategies, improving long-term transplant outcomes through personalized management approaches.
US claims data showed rising prevalence of diabetic retinal disease in type 1 and type 2 diabetes, while incidence declined in type 1 diabetes and moved closer to type 2 rates by 2022.
