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OBJECTIVES: Immunosuppressive medications are associated with increased diabetes among kidney transplant recipients. We used data from the USRDS database to estimate the incidence and the average cost to Medicare of new onset diabetes Mellitus (NODM). METHODS: The USRDS database merges the UNOS renal transplant registry with Medicare billing and payment records. The USRDS registry recorded 9,541 single‐organ, first, kidney transplants in 1996; 5,987 (63%) of these were not diabetic at transplantation. For the 4,515 (75% of 5,987) patients with Medicare claims, we merged all Medicare institutional and physician supplier claims records from 1996 through 1997 with the clinical information from UNOS. We classified patients as newly diabetic if any ICD‐9 diabetes diagnosis (250.00 to 250.79) occurred within one year of the patient's transplant. We then used a Kaplan‐Meier‐style non‐parametric calculation to estimate the average accumulated costs for patients with and without NODM. RESULTS: Among the 4,515 transplant recipients studied, 621 (13.7%) reported diabetes diagnoses within the first year post‐transplant. By the end of the first post‐transplant year, Medicare had paid $35,288 for each non‐diabetic recipient and an extra $17,614 (P = 0.001) for each of the NODM recipients. By two years post‐transplant, Medicare had paid an average $46,869 for each of the non‐diabetic recipients and an extra $26,032 for each of the NODM recipients (P = 0.001). CONCLUSIONS: Our 13.7% NODM exceeds the 2% to 5% previously reported, and the extra $26,032 is 55.5% above what Medicare paid for recipients without NODM. New immunosuppressives unassociated with NODM may generate substantial savings worldwide.

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