Galindo Rodolfo J, Fried Martin, Breen Tracy, Tamler Ronald
Endocr Pract. 2016 Apr;22(4):454-65. doi: 10.4158/EP151039.RA. Epub 2015 Dec 31.
Posttransplantation diabetes (PTDM) is a common occurrence after solid-organ transplantation and is associated with increased morbidity, mortality, and health care costs. There is a limited number of studies addressing strategies for hyperglycemia management in this population, with a few articles emerging recently.
We performed a PubMed search of studies published in English addressing hyperglycemia management of PTDM/new-onset diabetes after transplant (NODAT). Relevant cited articles were also retrieved.
Most of the 25 publications eligible for review were retrospective studies. Insulin therapy during the early posttransplantation period showed promise in preventing PTDM development. Thiazolidinediones have been mostly shown to exert glycemic control in retrospective studies, at the expense of weight gain and fluid retention. Evidence with metformin, sulfonylureas, and meglitinides is very limited. Incretins have shown promising results in small prospective studies using sitagliptin, linaglitpin, and vildagliptin and a case series using liraglutide.
Prospective randomized studies assessing the management of hyperglycemia in PTDM are urgently needed. In the meantime, clinicians need to be aware of the high risk of PTDM and associated complications and current concepts in management.
移植后糖尿病（PTDM）是实体器官移植后常见的情况，与发病率、死亡率及医疗费用增加相关。针对该人群高血糖管理策略的研究数量有限，近期仅有少数文章发表。
我们在PubMed上检索了以英文发表的关于PTDM/移植后新发糖尿病（NODAT）高血糖管理的研究。还检索了相关的引用文章。
符合综述条件的25篇出版物大多为回顾性研究。移植后早期使用胰岛素治疗在预防PTDM发生方面显示出前景。在回顾性研究中，噻唑烷二酮类药物大多显示出能控制血糖，但代价是体重增加和液体潴留。关于二甲双胍、磺脲类药物和格列奈类药物的证据非常有限。在使用西他列汀、利奈格列汀和维格列汀的小型前瞻性研究以及使用利拉鲁肽的病例系列中，肠促胰岛素显示出了有前景的结果。
迫切需要进行评估PTDM高血糖管理的前瞻性随机研究。与此同时，临床医生需要意识到PTDM的高风险及相关并发症以及当前的管理理念。
