Novonastala šećerna bolest nakon transplantacije organa

master's thesis

• Title (english): New onset diabetes mellitus after organ transplantation
• Author: Lucija Popović
• Mentor: Tomislav Bulum (mentor)
• Committee member: Tajana Filipec Kanižaj (predsjednik povjerenstva)
• Committee member: Ivana Vuković Brinar (član povjerenstva)
• Committee member: Tomislav Bulum (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Novonastala šećerna bolest nakon transplantacije organa česta je i ozbiljna posljedica transplantacije solidnih organa koja negativno utječe na funkciju presatka, preživljenje i kvalitetu života pacijenata. Dijagnosticira se na temelju kriterija za dijagnozu šećerne bolesti tipa 2, a zlatni standard za postavljanje dijagnoze je OGTT. Na razvoj NODAT-a utječu brojni rizični čimbenici koji se mogu podijeliti u dvije kategorije, promjenjive i nepromjenjive rizične čimbenike. Nakon transplantacije organa potrebno je u zadanim vremenskim intervalima kontrolirati glikemiju kako bi se dijagnoza NODAT-a postavila na vrijeme i što prije započela terapija te time spriječilo ili barem odgodilo nastajanje komplikacija šećerne bolesti. Terapijski pristup uključuje promjenu životnih navika te primjenu farmakoloških mjera, odnosno metformina, derivata sulfonilureje i glinida, tiazolidindiona, DPP-4 inhibitora, GLP-1 agonista, SGLT-2 inhibitora i inzulina. Smanjenje doze imunosupresivnih lijekova ili njihova zamjena drugim imunosupresivnim lijekovima koji imaju manje izražen dijabetogeni učinak, čest je pristup u prevenciji i terapiji NODAT-a, ali potreban je oprez zbog mogućnosti akutnog odbacivanja presatka što je znatno lošiji ishod za pacijenta od razvoja NODAT-a. Osim terapije šećerne bolesti, potrebno je djelovati i na druge komorbiditete, poput hipertenzije i dislipidemije, koji povećavaju rizik za nastanak neželjenih kardiovaskularnih događaja i povećavaju mortalitet pacijenata. Pacijenti s NODAT-om mogu razviti uobičajene komplikacije šećerne bolesti, dijabetičku nefropatiju, neuropatiju, retinopatiju i perifernu vaskularnu bolest, stoga su ključne redovite kontrole i adekvatna terapija kako bi se očuvala kvaliteta života i poboljšala prognoza.

Abstract (english)

New onset diabetes mellitus after organ transplantation is a frequent and serious consequence of solid organ transplantation that negatively affects the function of the graft, survival and quality of patient's life. It is diagnosed based on the criteria for the diagnosis of type 2 diabetes, and the gold standard for diagnosis is OGTT. The development of NODAT is influenced by numerous risk factors that can be divided into two categories, modifiable and non-modifiable risk factors. After organ transplantation, it is necessary to control glycemia at set time intervals to establish the diagnosis of NODAT on time and to start therapy as soon as possible, thereby preventing or at least delaying the development of diabetes complications. The therapeutic approach includes a change in lifestyle and the use of pharmacological measures, namely metformin, sulfonylureas and glinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors and insulin. Reducing the dose of immunosuppressive drugs or replacing them with other immunosuppressive drugs that have a less pronounced diabetogenic effect is a common approach in the prevention and treatment of NODAT, but caution is required due to the possibility of acute graft rejection, which is a significantly worse outcome for the patient than the development of NODAT. In addition to diabetes therapy, it is necessary to act on other comorbidities, such as hypertension and dyslipidemia, which increase the risk of unwanted cardiovascular events and increase patient mortality. Patients with NODAT can develop common complications of diabetes, diabetic nephropathy, neuropathy, ophthalmopathy and peripheral vascular disease, so regular check-ups and adequate therapy are essential to preserve the quality of life and improve the prognosis.

• Keywords: novonastala šećerna bolest nakon transplantacije organa (NODAT); rizični čimbenici; imunosupresivni lijekovi; liječenje; posljedice NODAT-a
• Keywords (english): new onset diabetes after organ transplantation (NODAT); risk factors; immunosuppressive drugs; treatment; consequences of NODAT
• Language: croatian
• URN:NBN: urn:nbn:hr:105:170487
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-06-25 16:35:09