“Calcium dependent phosphatase inhibitors (CNI) are core drugs for organ transplantation and autoimmune disease treatment, but long-term use can lead to drug-induced hyperglycemia, seriously affecting patient prognosis. The study revealed its multifaceted pathogenesis, including direct damage to pancreatic beta cells, interference with peripheral tissue insulin signaling pathways, and triggering inflammatory responses. Clinical studies have shown that the incidence of CNI related hyperglycemia is closely related to drug type, dosage, and individual patient factors. For high-risk patients, it is recommended to adjust the dose of CNI, switch to low metabolic toxicity drugs if necessary, and choose an appropriate hypoglycemic regimen based on blood glucose levels. In the future, it is necessary to further elucidate the molecular mechanisms of CNI metabolic toxicity, optimize individualized drug treatment strategies, and improve long-term prognosis for patients.”