Solid organ transplantation is now the standard of care for end-stage organ failure, and primary care physicians are frequently involved in the follow-up care of transplant recipients. New-onset diabetes mellitus after solid organ transplantation (NODAT) has emerged as an increasingly important determinant of outcomes and survival in transplant recipients. Transplant recipients are at high risk for developing prediabetes and overt diabetes mellitus due to a number of factors, including immunosuppressive therapies. This article presents an algorithmic approach with supporting evidence to provide a rational framework for selecting the appropriate therapy among numerous treatment options. Patient education and self-management are crucial for ensuring a successful outcome post transplantation.