Posttransplantationsdiabetes mellitus

Marc Albersmeyer1, Bernhard Gehr2, Andreas Liebl2, D. Gerbig1
1Abteilung Innere Medizin – Nephrologie, Transplantationsnachsorge, m&i-Fachklinik Bad Heilbrunn, Wörnerweg 30, 83670, Bad Heilbrunn, Deutschland
2Abteilung Innere Medizin – Diabetes- und Stoffwechselzentrum, m&i-Fachklinik Bad Heilbrunn, Wörnerweg 30, 83670, Bad Heilbrunn, Deutschland

Tóm tắt

ZusammenfassungNach Organtransplantation entwickeln etwa 10–40 % aller Patienten einen Posttransplantationsdiabetes mellitus (PTDM). Risikofaktoren sind Alter, Übergewicht, präexistenter Prädiabetes und Immunsuppression (Calcineurininhibitoren, Steroide). PTDM ist mit einer Steigerung der kardiovaskulären Mortalität assoziiert, mutmaßlich auch mit Transplantatversagen und daher in der Nachsorge von großer Bedeutung für Organerhalt und Langzeitüberleben. Als Goldstandard zur Diagnose gilt der orale Glukosetoleranztest (OGTT), unterstützend kommen Nüchternglukose, HbA1c- und Spontanblutzuckerwerte hinzu. Im Gegensatz zum Typ-2-Diabetes wird der PTDM in umgekehrter Reihenfolge behandelt: Direkt nach Transplantation wird vorzugsweise Insulin gegeben, im Verlauf kann oft deeskalierend auf eine orale Therapie (OAD) umgestellt werden. Hinsichtlich der Integration von OGTT, Diabeteseinstellung/‑schulung sowie Beratung zu gesunder Lebensführung in die Routine könnten stationäre Rehamaßnahmen in spezialisierten Zentren die Versorgungskette sinnvoll ergänzen.

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