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At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
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Diabetes Therapy
Published in: Diabetes Therapy 2/2018

Open Access 01-04-2018 | Review

Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment

Authors: Maria J. Peláez-Jaramillo, Allison A. Cárdenas-Mojica, Paula V. Gaete, Carlos O. Mendivil

Published in: Diabetes Therapy | Issue 2/2018

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Abstract

Post-liver transplantation diabetes mellitus (PLTDM) develops in up to 30% of liver transplant recipients and is associated with increased risk of mortality and multiple morbid outcomes. PLTDM is a multicausal disorder, but the main risk factor is the use of immunosuppressive agents of the calcineurin inhibitor (CNI) family (tacrolimus and cyclosporine). Additional factors, such as pre-transplant overweight, nonalcoholic steatohepatitis and hepatitis C virus infection, may further increase risk of developing PLTDM. A diagnosis of PLTDM should be established only after doses of CNI and steroids are stable and the post-operative stress has been overcome. The predominant defect induced by CNI is insulin secretory dysfunction. Plasma glucose control must start immediately after the transplant procedure in order to improve long-term results for both patient and transplant. Among the better known antidiabetics, metformin and DPP-4 inhibitors have a particularly benign profile in the PLTDM context and are the preferred oral agents for long-term management. Insulin therapy is also an effective approach that addresses the prevailing pathophysiological defect of the disorder. There is still insufficient evidence about the impact of newer families of antidiabetics (GLP-1 agonists, SGLT-2 inhibitors) on PLTDM. In this review, we summarize current knowledge on the epidemiology, pathogenesis, course of disease and medical management of PLTDM.
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Metadata
Title
Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment
Authors
Maria J. Peláez-Jaramillo
Allison A. Cárdenas-Mojica
Paula V. Gaete
Carlos O. Mendivil
Publication date
01-04-2018
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 2/2018
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-018-0374-8

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