Post-transplant metabolic dysregulation: Insights and implications for kidney graft survival

Table 2 Management of early post-transplant hyperglycemia

Category	Risk factors	Drug contributions	Potential benefits of newer therapies
Perioperative	Surgical stress, infection, high-dose steroids	Glucocorticoids → insulin resistance; CNIs (especially tacrolimus) → β-cell toxicity	Early basal insulin; CGM for tighter monitoring
Early outpatient	Weight gain, impaired graft function, pre-existing diabetes	Steroids → hyperglycemia; CNIs → impaired insulin secretion	DPP-4 inhibitors (linagliptin); GLP-1 receptor agonists
Monitoring	Obesity, family history	Steroids sustain hyperglycemia	Individualized HbA1c targets. Safer oral agents (meglitinides, sulfonylureas with low renal clearance)

CNIs: Calcineurin inhibitors; CGM: Continuous glucose monitoring; DPP-4: Dipeptidyl peptidase-4; GLP-1: Glucagon-like peptide-1; HbA1c: Hemoglobin A1c.