Managing the care of the diabetic transplant patient.

Care of the diabetic transplant patient presents many challenges for therapeutic management. Complications of diabetes such as retinopathy, neuropathy, hyperglycemia, and hypertension add to the already difficult management of nondiabetic transplant patients. The role of the pharmacist as an educator, counselor, and interaction and profile manager is an essential part of a successful transplant program. Understanding the purpose of the medications and their side effects is vital for the patient to comply with a demanding medication regimen. This depth of understanding cannot be conveyed without repetitive educational efforts that are reinforced by all of the health care practitioners and supportive family members. Although kidney transplantation offers freedom from dialysis, it does not offer freedom from insulin dependence. Kidney-pancreas, pancreas, or islet cell transplantation may provide insulin independence and are the only curative interventions available. Evaluation of the research literature compares the advantages and complications of these surgical modalities. Early intervention with transplantation may offer insulin-dependent diabetics a new opportunity to improve their quality of life; however, intensive educational efforts and assurance of compliance are essential for successful outcomes.