Criteria for prediabetes and posttransplant diabetes mellitus after kidney transplantation: A 2‐year diagnostic accuracy study of participants from a randomized controlled trial. Issue 12 (14th September 2022)

• Record Type: Journal Article
• Authors: Kurnikowski, Amelie; Nordheim, Espen; Schwaiger, Elisabeth; Krenn, Simon; Harreiter, Jürgen; Kautzky‐Willer, Alexandra; Leutner, Michael; Werzowa, Johannes; Tura, Andrea; Budde, Klemens; Eller, Kathrin; Pascual, Julio; Krebs, Michael; Jenssen, Trond Geir; Hecking, Manfred
• Is Part Of: American journal of transplantation. Volume 22:Issue 12(2022)
• Page Start: 2880
• Page End: 2891
• Publication Date: 2022-09-14
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.17187
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Posttransplant diabetes mellitus (PTDM) and prediabetes (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]) are associated with cardiovascular events. We assessed the diagnostic performance of fasting plasma glucose (FPG) and HbA1c as alternatives to oral glucose tolerance test (OGTT)‐derived 2‐hour plasma glucose (2hPG) using sensitivity and specificity in 263 kidney transplant recipients (KTRs) from a clinical trial. Between visits at 6, 12, and 24 months after transplantation, 28%–31% of patients switched glycemic category (normal glucose tolerance [NGT], IGT/IFG, PTDM). Correlations of FPG and HbA1c against 2hPG were lower at 6 months (r = 0.59 [FPG against 2hPG]; r = 0.45 [HbA1c against 2hPG]) vs. 24 months (r = 0.73 [FPG against 2hPG]; r = 0.74 [HbA1c against 2hPG]). Up to 69% of 2hPG‐defined PTDM cases were missed by conventional HbA1c and FPG thresholds. For prediabetes, concordance of FPG and HbA1c with 2hPG ranged from 6%–9%. In conclusion, in our well‐defined randomized trial cohort, one‐third of KTRs switched glycemic category over 2 years and although the correlations of FPG and HbA1c with 2hPG improved with time, their diagnostic concordance was poor for PTDM and, especially, prediabetes. Considering posttransplant metabolic instability, FPG's and HbA1c 's diagnostic performance, the OGTT remains indispensable to diagnose PTDM and prediabetes after kidney transplantation. Abstract : Analyses of data from kidney transplant recipients who participated in a randomized controlled trial show that the oral glucose tolerance test is indispensable to diagnose diabetes and pre‐diabetes because concordance between hemoglobin A1c and fasting plasma glucose tests is poor.