New-onset diabetes after transplantation: 2003 international consensus GUIDELINES1

J Davidson, A Wilkinson, J Dantal, F Dotta… - …, 2003 - journals.lww.com
J Davidson, A Wilkinson, J Dantal, F Dotta, H Haller, D HERNandez, BL Kasiske, B Kiberd
Transplantation, 2003journals.lww.com
Diabetes mellitus is 1one of the most common chronic diseases in the world, with an
estimated worldwide prevalence of over 176 million in 2000. Furthermore, the prevalence of
the disease is expected to increase in the coming years as industrialized societies become
older, more obese, and more sedentary, and it is predicted to rise to 370 million by 2030 (1).
Acute metabolic complications of diabetes are associated with high mortality rates; in
particular, hyperosmolar hyperglycemia (approximately 15%) and ketoacidosis (up to 5%) …
Diabetes mellitus is 1one of the most common chronic diseases in the world, with an estimated worldwide prevalence of over 176 million in 2000. Furthermore, the prevalence of the disease is expected to increase in the coming years as industrialized societies become older, more obese, and more sedentary, and it is predicted to rise to 370 million by 2030 (1). Acute metabolic complications of diabetes are associated with high mortality rates; in particular, hyperosmolar hyperglycemia (approximately 15%) and ketoacidosis (up to 5%). The prognosis in these conditions is substantially worse in older patients and those with coma or hypotension (2). Following a review of epidemiologic and pathologic evidence, the American Heart Association has also classified diabetes a major independent risk factor for cardiovascular disease (CVD)(3–8). Manifestations of CVD include atherosclerotic coronary heart disease (CHD), heart failure (diabetic cardiomyopathy), myocardial infarction, stroke, and peripheral vascular disease (7). The risk for stroke has been reported to be two to four times higher in patients with diabetes (7, 9). Furthermore, patients with diabetes who develop CVD have a worse prognosis for survival than patients with CVD but without diabetes (8–11). In fact, CVD is listed as the cause of death in approximately 65% of patients with diabetes (12).
In addition to the risk for macrovascular complications, diabetes is associated with long-term microvascular complications including neuropathy, retinopathy, nephropathy, and erectile dysfunction. Diabetic nephropathy is the most common single cause of end-stage renal disease in the United States and Europe (13). With respect to retinopathy, after 20 years with the condition, almost all individuals with type 1 diabetes and over 60% with type 2 diabetes have a degree of retinopathy that may progress to loss of vision (14). In fact, diabetes is now considered the leading cause of blindness in developed countries, causing 12,000 to 24,000 new cases each
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