How to identify and manage diabetes mellitus after renal transplantation

New-onset diabetes after transplantation (NODAT) has serious consequences for the patient in terms of overall survival, graft function and graft survival. The incidence of NODAT and impaired glucose tolerance has probably been underestimated previously because of lack of a universal diagnostic definition. Many risk factors have been identified, a proportion of which are modifiable. Early identification of those who are at high risk of NODAT and strategies to reduce risk will help to reduce the morbidity and mortality resulting from this condition. Where prevention is not possible, stringent management strategies are essential. Although, this article focuses on NODAT in the renal transplant recipient and considers the scale of the problem, impact on patient and transplant survival, determinants and risk factors for, and the management of, impaired glucose tolerance and NODAT, much of it will also be applicable to other types of solid organ transplantation.