BACKGROUND AND OBJECTIVES: Guidelines recommend that candidates for kidney transplantation (KTx) who do not have diabetes perform a pretransplantation oral glucose tolerance test (OGTT) when fasting plasma glucose (FPG) is <110 mg/dl (<6.1 mmol/L); however, the OGTT is potentially costly and cumbersome. We studied the role of the OGTT for diagnosing diabetes and the accuracy of FPG and glycated hemoglobin (HbA(1c)) for predicting a diabetic OGTT before KTx. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this cross-sectional study, 889 first single-kidney transplant candidates without diabetes, mainly white, performed an OGTT during the transplantation workup. Results were studied using receiver operating characteristic analysis. RESULTS: Of 72 (8.1%) patients with undiagnosed diabetes, only 16 (22%) had a diabetic FPG (> or =126 mg/dl [> or =7.0 mmol/L]). In patients with a nondiabetic FPG, diabetes (2-hour plasma glucose [2h-PG] > or =200 mg/dl [> or =11.1 mmol/L]) was predicted by FPG but not by HbA(1c). Performing the OGTT in patients with FPG 92 to 125 mg/dl (5.1 to 6.9 mmol/L) identified 65 (90%) patients with diabetes (16 by FPG, 49 by 2h-PG) and required seven OGTTs per patient identified. Subjecting all patients with FPG <110 mg/dl (<6.1 mmol/L) to the OGTT identified 60 (83%) patients with diabetes (16 by FPG, 44 by 2h-PG) but required 14 OGTTs per patient. CONCLUSIONS: The OGTT was paramount in finding most cases of undiagnosed diabetes before KTx. FPG but not HbA(1c) predicted a diabetic OGTT. We suggest that white KTx candidates without diabetes perform a pretransplantation OGTT when FPG is 92 to 125 mg/dl (5.1 to 6.9 mmol/L).
BACKGROUND AND OBJECTIVES: Guidelines recommend that candidates for kidney transplantation (KTx) who do not have diabetes perform a pretransplantation oral glucose tolerance test (OGTT) when fasting plasma glucose (FPG) is <110 mg/dl (<6.1 mmol/L); however, the OGTT is potentially costly and cumbersome. We studied the role of the OGTT for diagnosing diabetes and the accuracy of FPG and glycated hemoglobin (HbA(1c)) for predicting a diabetic OGTT before KTx. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this cross-sectional study, 889 first single-kidney transplant candidates without diabetes, mainly white, performed an OGTT during the transplantation workup. Results were studied using receiver operating characteristic analysis. RESULTS: Of 72 (8.1%) patients with undiagnosed diabetes, only 16 (22%) had a diabetic FPG (> or =126 mg/dl [> or =7.0 mmol/L]). In patients with a nondiabetic FPG, diabetes (2-hour plasma glucose [2h-PG] > or =200 mg/dl [> or =11.1 mmol/L]) was predicted by FPG but not by HbA(1c). Performing the OGTT in patients with FPG 92 to 125 mg/dl (5.1 to 6.9 mmol/L) identified 65 (90%) patients with diabetes (16 by FPG, 49 by 2h-PG) and required seven OGTTs per patient identified. Subjecting all patients with FPG <110 mg/dl (<6.1 mmol/L) to the OGTT identified 60 (83%) patients with diabetes (16 by FPG, 44 by 2h-PG) but required 14 OGTTs per patient. CONCLUSIONS: The OGTT was paramount in finding most cases of undiagnosed diabetes before KTx. FPG but not HbA(1c) predicted a diabetic OGTT. We suggest that white KTx candidates without diabetes perform a pretransplantation OGTT when FPG is 92 to 125 mg/dl (5.1 to 6.9 mmol/L).
Authors: Tone G Valderhaug; Trond Jenssen; Anders Hartmann; Karsten Midtvedt; Hallvard Holdaas; Anna V Reisaeter; Jøran Hjelmesaeth Journal: Transplantation Date: 2009-08-15 Impact factor: 4.939
Authors: Jonathan A C Sterne; Ian R White; John B Carlin; Michael Spratt; Patrick Royston; Michael G Kenward; Angela M Wood; James R Carpenter Journal: BMJ Date: 2009-06-29
Authors: A Sharif; M Hecking; A P J de Vries; E Porrini; M Hornum; S Rasoul-Rockenschaub; G Berlakovich; M Krebs; A Kautzky-Willer; G Schernthaner; P Marchetti; G Pacini; A Ojo; S Takahara; J L Larsen; K Budde; K Eller; J Pascual; A Jardine; S J L Bakker; T G Valderhaug; T G Jenssen; S Cohney; M D Säemann Journal: Am J Transplant Date: 2014-08-06 Impact factor: 8.086
Authors: T G Valderhaug; J Hjelmesæth; A Hartmann; J Røislien; H A Bergrem; T Leivestad; P D Line; T Jenssen Journal: Diabetologia Date: 2011-03-16 Impact factor: 10.122