Advertisement

Current Diabetes Reports

, 16:14 | Cite as

Hyperglycemia and Diabetes Mellitus Following Organ Transplantation

  • Rodolfo J. Galindo
  • Amisha Wallia
Hospital Management of Diabetes (GE Umpierrez, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hospital Management of Diabetes

Abstract

Hyperglycemia is common following organ transplantation, regardless of the pre-transplant diabetes status. Transient post-transplant hyperglycemia and/or new-onset diabetes after transplantation (NODAT) are common and are associated with increased morbidity and mortality. NODAT and type 2 diabetes share similar characteristics, but the pathophysiology may differ. Immunosuppressive agents and steroids play a key role in the development of NODAT. Glycemic control is challenging in this population due to fluctuating renal/end-organ function, immunosuppressive dosing, nutritional status, and drug-drug interactions. A proactive and multidisciplinary approach is essential, along with flexible protocols to adjust to patient status, type of organ transplanted, and corticosteroid regimens. Insulin is the preferred agent for hospitalized patients and during the early post-transplant period; optimal glycemic control (BG < 180 mg/dl with minimal hypoglycemia [<70 mg/dl]) is desired.

Keywords

Hyperglycemia Organ transplantation Post-transplant diabetes New-onset diabetes after transplantation Diabetes mellitus Outcomes 

Notes

Compliance with Ethical Standards

Conflict of Interest

Rodolfo J. Galindo declares that he has no conflict of interest. Amisha Wallia currently receives research salary support from Merck Sharp and Dohme Corp.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Chakkera HA, Weil EJ, Castro J, et al. Hyperglycemia during the immediate period after kidney transplantation. Clin J Am Soc Nephrol. 2009;4:853–9.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Thomas MC, Moran J, Mathew TH, et al. Early peri-operative hyperglycaemia and renal allograft rejection in patients without diabetes. BMC Nephrol. 2000;1:1.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    First MR, Dhadda S, Croy R, et al. New-onset diabetes after transplantation (nodat): an evaluation of definitions in clinical trials. Transplantation. 2013;96:58–64.CrossRefPubMedGoogle Scholar
  4. 4.••
    Sharif A, Hecking M, de Vries AP, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant. 2014;14:1992–2000. This article represents the most recent updated guidelines regarding the diagnosis and treatment of post-transplant diabetes mellitus. The consensus meeting was held in September 8-9th, 2013.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metabol. 2002;87:978–82.CrossRefGoogle Scholar
  6. 6.
    van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.CrossRefPubMedGoogle Scholar
  7. 7.
    NICE-SUGAR Study Investigators et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.CrossRefGoogle Scholar
  8. 8.
    Davidson J, Wilkinson A, Dantal J, et al. New-onset diabetes after transplantation: 2003 international consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation. 2003;75:SS3–24.CrossRefPubMedGoogle Scholar
  9. 9.
    American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015;38:S8–S16.CrossRefGoogle Scholar
  10. 10.
    Shabir S, Jham S, Harper L, et al. Validity of glycated haemoglobin to diagnose new onset diabetes after transplantation. Transpl Int. 2013;26:315–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Hecking M, Werzowa J, Haidinger M, et al. Novel views on new-onset diabetes after transplantation: development, prevention and treatment. Nephrol Dial Transplant. 2013;28:550–66.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Hecking M, Kainz A, Werzowa J, et al. Glucose metabolism after renal transplantation. Diabetes Care. 2013;36:2763–71.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Pham PT, Pham PC, Lipshutz GS, et al. New onset diabetes mellitus after solid organ transplantation. Endocrinol Metab Clin N Am. 2007;36:873–90.CrossRefGoogle Scholar
  14. 14.
    Midtvedt K, Hartmann A, Hjelmesaeth J, et al. Insulin resistance is a common denominator of post-transplant diabetes mellitus and impaired glucose tolerance in renal transplant recipients. Nephrol Dial Transplant. 1998;13:427–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Bayes B, Granada ML, Pastor MC, et al. Obesity, adiponectin and inflammation as predictors of new-onset diabetes mellitus after kidney transplantation. Am J Transplant. 2007;7:416–22.CrossRefPubMedGoogle Scholar
  16. 16.
    van Raalte DH, Ouwens DM, Diamant M. Novel insights into glucocorticoid-mediated diabetogenic effects: towards expansion of therapeutic options? Eur J Clin Investig. 2009;39:81–93.CrossRefGoogle Scholar
  17. 17.
    Chakkera HA, Mandarino LJ. Calcineurin inhibition and new-onset diabetes mellitus after transplantation. Transplantation. 2013;95:647–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Araki M, Flechner SM, Ismail HR, et al. Posttransplant diabetes mellitus in kidney transplant recipients receiving calcineurin or mtor inhibitor drugs. Transplantation. 2006;81:335–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Soleimanpour SA, Crutchlow MF, Ferrari AM, et al. Calcineurin signaling regulates human islet beta-cell survival. J Biol Chem. 2010;285:40050–9.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Barlow AD, Nicholson ML, Herbert TP. Evidence for rapamycin toxicity in pancreatic β-cells and a review of the underlying molecular mechanisms. Diabetes. 2013;62:2674–82.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Masson P, Henderson L, Chapman JR, et al. Belatacept for kidney transplant recipients. Cochrane Database Syst Rev. 2014;11:CD010699.PubMedGoogle Scholar
  22. 22.•
    Hackman KL, Snell GI, Bach LA. Prevalence and predictors of diabetes after lung transplantation: a prospective, longitudinal study. Diabetes Care. 2014;37:2919–25. This prospective longitudinal study evaluated glycemic status pre- and post-lung transplantation with the use of frequent oral glucose tolerance testing over time.CrossRefPubMedGoogle Scholar
  23. 23.
    Hecking M, Haidinger M, Döller D, et al. Early basal insulin therapy decreases new-onset diabetes after renal transplantation. J Am Soc Nephrol. 2012;23:739–49.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Lund LH, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: thirtieth official adult heart transplant report--2013; focus theme: age. J Heart Lung Transplant. 2013;32:951–64.CrossRefPubMedGoogle Scholar
  25. 25.
    Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2012 annual data report: kidney. Am J Transplant. 2014;14 Suppl 1:11–44.CrossRefPubMedGoogle Scholar
  26. 26.
    Chakkera HA, Knowler WC, Devarapalli Y, et al. Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus. Clin J Am Soc Nephrol. 2010;5:1669–75.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Kasiske BL, Snyder JJ, Gilbertson D, et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003;3:178–85.CrossRefPubMedGoogle Scholar
  28. 28.
    Yadav AD, Chang YH, Aqel BA, et al. New onset diabetes mellitus in living donor versus deceased donor liver transplant recipients: analysis of the UNOS/OPTN database. J Transplant. 2013;2013:269096.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Kuo HT, Sampaio MS, Ye X, et al. Risk factors for new-onset diabetes mellitus in adult liver transplant recipients, an analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database. Transplantation. 2010;89:1134–40.CrossRefPubMedGoogle Scholar
  30. 30.
    Saraiva J, Sola E, Prieto D, et al. Diabetes as an outcome predictor after heart transplantation. Interact Cardiovasc Thorac Surg. 2011;13:499–504.CrossRefPubMedGoogle Scholar
  31. 31.
    Ye X, Kuo HT, Sampaio MS, et al. Risk factors for development of new-onset diabetes mellitus in adult heart transplant recipients. Transplantation. 2010;89:1526–32.CrossRefPubMedGoogle Scholar
  32. 32.
    Ollech JE, Kramer MR, Peled N, et al. Post-transplant diabetes mellitus in lung transplant recipients: incidence and risk factors. Eur J Cardiothorac Surg. 2008;33:844–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Montori VM, Basu A, Erwin PJ, et al. Posttransplantation diabetes: a systematic review of the literature. Diabetes Care. 2002;25:583–92.CrossRefPubMedGoogle Scholar
  34. 34.
    Cosio FG, Pesavento TE, Kim S, et al. Patient survival after renal transplantation: impact of post-transplant diabetes. Kidney Int. 2002;62:1440–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Thomas MC, Mathew TH, Russ GR, et al. Early peri-operative glycaemic control and allograft rejection in patients with diabetes mellitus: a pilot study. Transplantation. 2001;72:1321–4.CrossRefPubMedGoogle Scholar
  36. 36.
    Cosio FG, Kudva Y, van der Velde M, et al. New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int. 2005;67:2415–21.CrossRefPubMedGoogle Scholar
  37. 37.
    Burroughs TE, Swindle J, Takemoto S, et al. Diabetic complications associated with new-onset diabetes mellitus in renal transplant recipients. Transplantation. 2007;83:1027–34.CrossRefPubMedGoogle Scholar
  38. 38.•
    Hermayer KL, Egidi MF, Finch NJ, et al. A randomized controlled trial to evaluate the effect of glycemic control on renal transplantation outcomes. J Clin Endocrinol Metabol. 2012;97:4399–406. This study is a randomized controlled clinical trial in the renal transplant population evaluating a subcutaneous vs. intravenous insulin therapy regimen, showing no difference in delayed graft function, but increased hypoglycemia in the IV insulin therapy group.CrossRefGoogle Scholar
  39. 39.
    Li P, Hunt KJ, Taber DJ, et al. Inflammatory biomarkers, glycemic variability, hypoglycemia, and renal transplant outcomes: results of a randomized controlled trial. Transplantation. 2014;98:632–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Matas AJ, Gillingham KJ, Elick BA, et al. Risk factors for prolonged hospitalization after kidney transplants. Clin Transpl. 1997;11:259–64.Google Scholar
  41. 41.
    Woodward RS, Schnitzler MA, Baty J, et al. Incidence and cost of new onset diabetes mellitus among U.S. wait-listed and transplanted renal allograft recipients. Am J Transplant. 2003;3:590–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Moon JI, Barbeito R, Faradji RN, et al. Negative impact of new-onset diabetes mellitus on patient and graft survival after liver transplantation: long-term follow up. Transplantation. 2006;82:1625–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Ammori JB, Sigakis M, Englesbe MJ, et al. Effect of intraoperative hyperglycemia during liver transplantation. J Surg Res. 2007;140:227–33.CrossRefPubMedGoogle Scholar
  44. 44.
    Darstein F, Konig C, Hoppe-Lotichius M et al. New onset of diabetes after transplantation is associated with improved patient survival after liver transplantation due to confounding factor. Eur J Intern Med. 2015.Google Scholar
  45. 45.
    Wallia A, Parikh ND, Molitch ME, et al. Posttransplant hyperglycemia is associated with increased risk of liver allograft rejection. Transplantation. 2010;89:222–6.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Park C, Hsu C, Neelakanta G, et al. Severe intraoperative hyperglycemia is independently associated with surgical site infection after liver transplantation. Transplantation. 2009;87:1031–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Wallia A, Parikh N, O’Shea-Mahler E, et al. Glycemic control by a glucose management service and infection rates after liver transplantation. Endocr Pract. 2011;17:546–51.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Hoehn RS, Singhal A, Wima K, et al. Effect of pretransplant diabetes on short-term outcomes after liver transplantation: a national cohort study. Liver Int. 2015;35:1902–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Axelrod DA, Dzebisashvili N, Lentine K, et al. Assessing variation in the costs of care among patients awaiting liver transplantation. Am J Transplant. 2014;14:70–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Marelli D, Laks H, Patel B, et al. Heart transplantation in patients with diabetes mellitus in the current era. J Heart Lung Transplant. 2003;22:1091–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Kilic A, Weiss ES, George TJ, et al. What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors. Ann Thorac Surg. 2012;93:699–704.CrossRefPubMedGoogle Scholar
  52. 52.
    Higgins J, Pflugfelder PW, Kostuk WJ. Increased morbidity in diabetic cardiac transplant recipients. Can J Cardiol. 2009;25:e125–9.PubMedCentralCrossRefPubMedGoogle Scholar
  53. 53.
    Russo MJ, Chen JM, Hong KN, et al. Survival after heart transplantation is not diminished among recipients with uncomplicated diabetes mellitus: an analysis of the United Network of Organ Sharing database. Circulation. 2006;114:2280–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Lang CC, Beniaminovitz A, Edwards N, et al. Morbidity and mortality in diabetic patients following cardiac transplantation. J Heart Lung Transplant. 2003;22:244–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Garcia C, Wallia A, Gupta S, et al. Intensive glycemic control after heart transplantation is safe and effective for diabetic and non-diabetic patients. Clin Transpl. 2013;27:444–54.CrossRefGoogle Scholar
  56. 56.
    Yusen RD, Christie JD, Edwards LB, et al. The registry of the international society for heart and lung transplantation: thirtieth adult lung and heart-lung transplant report--2013; focus theme: age. Am J Transplant. 2013;32:965–78.Google Scholar
  57. 57.
    Hackman KL, Bailey MJ, Snell GI, et al. Diabetes is a major risk factor for mortality after lung transplantation. Am J Transplant. 2014;14:438–45.CrossRefPubMedGoogle Scholar
  58. 58.
    Bradbury RA, Shirkhedkar D, Glanville AR, et al. Prior diabetes mellitus is associated with increased morbidity in cystic fibrosis patients undergoing bilateral lung transplantation: an ‘orphan’ area? A retrospective case–control study. Intern Med J. 2009;39:384–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Hofer M, Schmid C, Benden C, et al. Diabetes mellitus and survival in cystic fibrosis patients after lung transplantation. J Cyst Fibros. 2012;11:131–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Hayes D, Jr., Patel AV, Black SM et al. Influence of diabetes on survival in patients with cystic fibrosis before and after lung transplantation. J Thorac Cardiovasc Surg. 2015.Google Scholar
  61. 61.
    Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metabol. 2012;97:16–38.CrossRefGoogle Scholar
  62. 62.
    Jacobi J, Bircher N, Krinsley J, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012;40:3251–76.CrossRefPubMedGoogle Scholar
  63. 63.
    American Diabetes Association. Diabetes care in the hospital, nursing home, and skilled nursing facility. Diabetes Care. 2015;38:S80–5.CrossRefGoogle Scholar
  64. 64.
    Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32:1119–31.PubMedCentralCrossRefPubMedGoogle Scholar
  65. 65.
    Umpierrez G, Cardona S, Pasquel F, et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG trial. Diabetes Care. 2015;38:1665–72.CrossRefPubMedGoogle Scholar
  66. 66.
    Desai K, Gandhi G, Shoraka A et al. Outcomes with intensive glycemic control in liver transplantation: a randomized controlled trial [abstract]. Diabetes. 2015;64 (suppl 1).Google Scholar
  67. 67.
    Wallia A, Gupta S, Garcia C, et al. Examination of implementation of intravenous and subcutaneous insulin protocols and glycemic control in heart transplant patients. Endocr Pract. 2014;20:527–35.CrossRefPubMedGoogle Scholar
  68. 68.
    Keegan MT, Vrchota JM, Haala PM, et al. Safety and effectiveness of intensive insulin protocol use in post-operative liver transplant recipients. Transplant Proc. 2010;42:2617–24.CrossRefPubMedGoogle Scholar
  69. 69.
    Gupta S, Oakes DJ, Therasse A et al. Extreme insulin resistance following heart transplant. In: Boris Draznin, editor. Diabetes Case Studies: Real Problems, Practical Solutions. American Diabetes Association; 2015. 214–7Google Scholar
  70. 70.
    Schmeltz LR, DeSantis AJ, Schmidt K, et al. Conversion of intravenous insulin infusions to subcutaneously administered insulin glargine in patients with hyperglycemia. Endocr Pract. 2006;12:641–50.CrossRefPubMedGoogle Scholar
  71. 71.
    Dungan K, Hall C, Schuster D, et al. Differential response between diabetes and stress-induced hyperglycaemia to algorithmic use of detemir and flexible mealtime aspart among stable postcardiac surgery patients requiring intravenous insulin. Diabetes Obes Metab. 2011;13:1130–5.PubMedCentralCrossRefPubMedGoogle Scholar
  72. 72.
    Dickerson RN, Wilson VC, Maish GO, et al. Transitional nph insulin therapy for critically ill patients receiving continuous enteral nutrition and intravenous regular human insulin. JPEN J Parenter Enteral Nutr. 2013;37:506–16.CrossRefPubMedGoogle Scholar
  73. 73.
    Baldwin D, Zander J, Munoz C, et al. A randomized trial of two weight-based doses of insulin glargine and glulisine in hospitalized subjects with type 2 diabetes and renal insufficiency. Diabetes Care. 2012;35:1970–4.PubMedCentralCrossRefPubMedGoogle Scholar
  74. 74.
    Burt MG, Roberts GW, Aguilar-Loza NR, et al. Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metabol. 2011;96:1789–96.CrossRefGoogle Scholar
  75. 75.
    Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract. 2009;15:469–74.CrossRefPubMedGoogle Scholar
  76. 76.
    Seggelke SA, Gibbs J, Draznin B. Pilot study of using neutral protamine hagedorn insulin to counteract the effect of methylprednisolone in hospitalized patients with diabetes. J Hosp Med. 2011;6:175–6.CrossRefPubMedGoogle Scholar
  77. 77.
    Dhital SM, Shenker Y, Meredith M, et al. A retrospective study comparing neutral protamine hagedorn insulin with glargine as basal therapy in prednisone-associated diabetes mellitus in hospitalized patients. Endocr Pract. 2012;18:712–9.PubMedCentralCrossRefPubMedGoogle Scholar
  78. 78.
    Kreider KE, Lien LF. Transitioning safely from intravenous to subcutaneous insulin. Curr Diab Rep. 2015;15:23.CrossRefPubMedGoogle Scholar
  79. 79.
    Umpierrez GE, Schwartz S. Use of incretin-based therapy in hospitalized patients with hyperglycemia. Endocr Pract. 2014;20:933–44.CrossRefPubMedGoogle Scholar
  80. 80.
    van Raalte DH, van Genugten RE, Linssen MM, et al. Glucagon-like peptide-1 receptor agonist treatment prevents glucocorticoid-induced glucose intolerance and islet-cell dysfunction in humans. Diabetes Care. 2011;34:412–7.PubMedCentralCrossRefPubMedGoogle Scholar
  81. 81.
    Umpierrez GE, Gianchandani R, Smiley D, et al. Safety and efficacy of sitagliptin therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes: a pilot, randomized, controlled study. Diabetes Care. 2013;36:3430–5.PubMedCentralCrossRefPubMedGoogle Scholar
  82. 82.
    Umpierrez GE, Reyes D, Smiley D, et al. Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care. 2014;37:2934–9.PubMedCentralCrossRefPubMedGoogle Scholar
  83. 83.
    Wallia A, Molitch ME. Insulin therapy for type 2 diabetes mellitus. JAMA. 2014;311:2315–25.CrossRefPubMedGoogle Scholar
  84. 84.
    Therasse A, Wallia A, Molitch ME. Management of post-transplant diabetes. Curr Diab Rep. 2013;13:121–9.CrossRefPubMedGoogle Scholar
  85. 85.
    American Diabees Association. Glycemic targets. Diabetes Care. 2015;38:S33–40.CrossRefGoogle Scholar
  86. 86.
    U.S. Renal Data System Annual Data. Medications for diabetes control in the first six months post-transplant, 2009–2011. Atlas of chronic kidney disease and end-stage renal disease in the United States, 2013.Google Scholar
  87. 87.
    Moen MF, Zhan M, Hsu VD, et al. Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol. 2009;4:1121–7.PubMedCentralCrossRefPubMedGoogle Scholar
  88. 88.
    Biesenbach G, Raml A, Schmekal B, et al. Decreased insulin requirement in relation to gfr in nephropathic type 1 and insulin-treated type 2 diabetic patients. Diabet Med. 2003;20:642–5.CrossRefPubMedGoogle Scholar
  89. 89.
    Sharif A, Moore R, Baboolal K. Influence of lifestyle modification in renal transplant recipients with postprandial hyperglycemia. Transplantation. 2008;85:353–8.CrossRefPubMedGoogle Scholar
  90. 90.
    Alexander JW, Metze TJ, McIntosh MJ, et al. The influence of immunomodulatory diets on transplant success and complications. Transplantation. 2005;79:460–5.CrossRefPubMedGoogle Scholar
  91. 91.
    Chakkera HA, Weil EJ, Pham PT, et al. Can new-onset diabetes after kidney transplant be prevented? Diabetes Care. 2013;36:1406–12.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of Endocrinology, Diabetes, and Bone DiseasesIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Division of Endocrinology, Metabolism and Molecular Medicine, Center for Healthcare StudiesNorthwestern University Feinberg School of MedicineChicagoUSA

Personalised recommendations