Correspondence regarding the impact of kidney transplantation on insulin sensitivity

Bergfeld, Léon; Werzowa, Johannes; Säemann, Marcus D.; Hecking, Manfred

doi:10.1111/tri.13124

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Furthermore, from a mechanistic point of view, tacrolimus seems to interact with free fatty acids to impair beta cell function [67]. The recent re‐classification of individuals from the general population with type 1 diabetes, type 2 diabetes, and late autoimmune diabetes in adults into 5 novel categories (clusters), by their degree of insulin deficiency, respective to insulin resistance [68] may help the PTDM community in solving the conflict whether it is impaired insulin secretion [61,62,69] or higher insulin resistance that dominates the pathophysiology of PTDM patients [70]. As in the general population, there may be individual differences in PTDM patients, which are further modified by the type of immunosuppression that these individuals are receiving after solid organ transplantation.…”

Section: Management Of Ptdm: Immunosuppressionmentioning

confidence: 99%

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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Summary Post‐transplant diabetes mellitus (PTDM) shows a relationship with risk factors including obesity and tacrolimus‐based immunosuppression, which decreases pancreatic insulin secretion. Several of the sodium–glucose‐linked transporter 2 inhibitors (SGLT2is) and glucagon‐like peptide 1 receptor agonists (GLP1‐RAs) dramatically improve outcomes of individuals with type 2 diabetes with and without chronic kidney disease, which is, as heart failure and atherosclerotic cardiovascular disease, differentially affected by both drug classes (presumably). Here, we discuss SGLT2is and GLP1‐RAs in context with other PTDM management strategies, including modification of immunosuppression, active lifestyle intervention, and early postoperative insulin administration. We also review recent studies with SGLT2is in PTDM, reporting their safety and antihyperglycemic efficacy, which is moderate to low, depending on kidney function. Finally, we reference retrospective case reports with GLP1‐RAs that have not brought forth major concerns, likely indicating that GLP1‐RAs are ideal for PTDM patients suffering from obesity. Although our article encompasses PTDM after solid organ transplantation in general, data from kidney transplant recipients constitute the largest proportion. The PTDM research community still requires data that treating and preventing PTDM will improve clinical conditions beyond hyperglycemia. We therefore suggest that it is time to collaborate, in testing novel antidiabetics among patients of all transplant disciplines.

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Section: Management Of Ptdm: Immunosuppressionmentioning

confidence: 99%

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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“…Posttransplantation diabetes mellitus (PTDM) remains common after kidney transplantation, but the controversy over its pathophysiological mechanism has not been resolved. 1,2 We previously found that insulin sensitivity at similar oral glucose tolerance test (OGTT)-derived 2-hour glucose was higher in kidney transplant recipients (KTRs) than in nontransplanted general population control subjects, while insulin release was lower. 3 Our earlier study was lacking a transplanted control group, and the KTR group comprised both, tacrolimusand cyclosporine-treated patients, although tacrolimus and cyclosporine portend meaningful differences in diabetes risk.…”

Section: To the Editormentioning

confidence: 99%

Glucose Metabolism After Kidney Transplantation: Insulin Release and Sensitivity With Tacrolimus- Versus Belatacept-Based Immunosuppression

Müller

Schwaiger

Kurnikowski

et al. 2021

American Journal of Kidney Diseases

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“…33 Transplant professionals should consider tailoring PTD management based on the dominant pathophysiology for individual patients (see Figure 2). 34 Diverse and heterogeneous posttransplant patients are likely to manifest varied presentations of PTD requiring targeted intervention. Pharmacotherapy selection for PTD must consider potential effects and side effects with evidence-based predominately translated from the general population (see Table 1 and Figure 3).…”

Section: Targeted Therapy Based On Ptd Characteristicsmentioning

confidence: 99%

Interventions Against Posttransplantation Diabetes: A Scientific Rationale for Treatment Hierarchy Based on Literature Review

Sharif

2022

Transplantation

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Posttransplant diabetes (PTD) is a common medical complication after solid organ transplantation. Because of adverse outcomes associated with its development and detrimental impact on long-term survival, strategies to prevent or manage PTD are critically important but remain underresearched. Treatment hierarchies of antidiabetic therapies in the general population are currently being revolutionized based on cardiovascular outcome trials, providing evidence-based rationale for optimization of medical management. However, opportunities for improving medical management of PTD are challenged by 2 important considerations: (1) translating clinical evidence data from the general population to underresearched solid organ transplant cohorts and (2) targeting treatment based on primary underlying PTD pathophysiology. In this article, the aim is to provide an overview of PTD treatment options from a new angle. Rationalized by a consideration of underlying PTD pathophysiological defects, which are heterogeneous among diverse transplant patient cohorts, a critical appraisal of the published literature and summary of current research in progress will be reviewed. The aim is to update transplant professionals regarding medical management of PTD from a new perspective tailored therapeutic intervention based on individualized characteristics. As the gap in clinical evidence between management of PTD versus type 2 diabetes widens, it is imperative for the transplant community to bridge this gap with targeted clinical trials to ensure we optimize outcomes for solid organ transplant recipients who are at risk or develop PTD. This necessary clinical research should help efforts to improve long-term outcomes for solid transplant patients from both a patient and graft survival perspective.

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Correspondence regarding the impact of kidney transplantation on insulin sensitivity

Cited by 5 publications

References 10 publications

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Glucose Metabolism After Kidney Transplantation: Insulin Release and Sensitivity With Tacrolimus- Versus Belatacept-Based Immunosuppression

Interventions Against Posttransplantation Diabetes: A Scientific Rationale for Treatment Hierarchy Based on Literature Review

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