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Title: Screening for new-onset diabetes after kidney transplantation: limitations of fasting glucose and advantages of afternoon glucose and glycated hemoglobin.
Authors: Cohney, Solomon (Shlomo)
Other Authors: Yates, Christopher
Fourlanos, S.
Colman, P. C.
Keywords: Blood Glucose
Circadian Rhythm
Glucose Tolerance Test
Graft Rejection
Hemoglobin A
Immunosuppressive Agents
Kidney Transplantation
Mycophenolic Acid
Postoperative Complications
Fasting Plasma Glucose
New-Onset Diabetes After Transplantation
Oral Glucose Tolerance Testing
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Department of Nephrology, Epworth HealthCare, Richmond, Victoria, Australia.
Issue Date: Nov-2013
Publisher: Wolters Kluwer
Citation: Transplantation. 2013 Oct 27;96(8):726-31
Abstract: BACKGROUND: The sensitivity of fasting plasma glucose (FPG) in screening for new-onset diabetes after transplantation (NODAT) has been questioned, particularly in the presence of moderate-dose prednisolone, where peak plasma glucose occurs 7 to 8 hr after administration. Oral glucose tolerance testing (OGTT) has been mooted as an alternative but is inconvenient for patients. METHODS: We compared sensitivity of screening tests for NODAT at 6 weeks, 3 months, and 12 months after kidney transplantation in recipients receiving prednisolone, mycophenolate, and tacrolimus. RESULTS: At 6 weeks, NODAT (capillary blood glucose [CapBG] ≥11.1 mmol/L, FPG ≥7.0 mmol/L, 2-hr plasma glucose ≥11.1 mmol/L, or glycated hemoglobin [HbA1c] ≥6.5%) was detected in 46% with CapBG versus 12% with OGTT (P=0.013), 4% with HbA1c (P<0.001), and 0% with FPG (P<0.001; n=26). At 3 months, NODAT was present in 14% with HbA1c versus 20% with OGTT (P=0.600) and 2% with FPG (P=0.059; n=50), whereas, at 12 months, NODAT was found in 4% with HbA1c versus 6% with OGTT (P=1.00) and 2% with FPG (P=0.618; n=51). Combining 3- and 12-month data, OGTT recorded NODAT in 14% and impaired glucose tolerance in 28%, whereas HbA1c detected NODAT in 10% and impaired glucose tolerance (from ≥5.7 to <6.5%) in 51%. Employing HbA1c as a screening test and reserving OGTT for those with impaired glucose tolerance would detect NODAT with a sensitivity more than 94%, avoiding the need for OGTT in 49% of patients. CONCLUSIONS: This study confirms the inadequacy of FPG screening for NODAT in the first 6 weeks after transplantation, at which time 4 p.m. CapBG also outperformed OGTT. From 3 months, HbA1c had similar sensitivity to OGTT and represents a convenient alternative.
DOI: 10.1097/TP.0b013e3182a012f3
PubMed URL:
ISSN: 1534-6080
Journal Title: Transplantation
Type: Journal Article
Affiliated Organisations: Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Renal Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Medicine, NorthWest Academic Centre, University of Melbourne, St Albans, Victoria, Australia
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:UroRenal, Vascular

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