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Fasting plasma glucose and glycosylated hemoglobin in the screening for diabetes mellitus after renal transplantation.
Transplantation. 2009 Aug 15; 88(3):429-34.T

Abstract

BACKGROUND

Fasting plasma glucose (fPG) is recommended to identify new-onset posttransplant diabetes mellitus (PTDM), but an oral glucose tolerance test (OGTT) has higher diagnostic sensitivity. We aimed to assess the accuracy of fPG and glycosylated hemoglobin (HbA1c) for the selection of patients who should undergo a diagnostic OGTT 10 weeks after renal transplantation.

METHODS

A total of 1571 renal transplant recipients without prior diabetes underwent an OGTT 10 weeks after transplantation. Receiver operating characteristic analyses were used to identify optimal thresholds to incite further diagnostic tests. A sensitivity level of 80% was chosen for screening purpose.

RESULTS

We diagnosed PTDM in 213 (14%) patients of whom 109 (51%) were identified by 2-hr plasma glucose more than or equal to 11.1 mmol/L alone, 35 (17%) by fPG alone, and 69 (32%) by both criteria. Receiver operating characteristic analysis revealed an area under the curve of 0.761 (95% confidence interval 0.714-0.809) for fPG and 0.817 (95% confidence interval 0.758-0.876) for HbA1c. Performing an OGTT on patients with an fPG more than or equal to 5.3 mmol/L or HbA1c more than or equal to 5.8% predicted diabetes with 81% and 83% sensitivity, requiring 49% and 41% of the patients to be tested, respectively. The combined criterion fPG more than or equal to 5.0 mmol/L and HbA1c more than or equal to 5.7%, provided a similar sensitivity (79%) from testing only 29% of the population.

CONCLUSION

We conclude that patients with an fPG between 5.3 and 6.9 mmol/L or HbA1c more than or equal to 5.8%, alternatively an fPG more than or equal to 5.0 mmol/L combined with HbA1c more than or equal to 5.7% in the early posttransplant period should undergo an OGTT for diagnostic verification of PTDM.

Authors+Show Affiliations

Medical Department, Rikshospitalet, University of Oslo, Norway. t.g.valderhaug@medisin.uio.noNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19667949

Citation

Valderhaug, Tone G., et al. "Fasting Plasma Glucose and Glycosylated Hemoglobin in the Screening for Diabetes Mellitus After Renal Transplantation." Transplantation, vol. 88, no. 3, 2009, pp. 429-34.
Valderhaug TG, Jenssen T, Hartmann A, et al. Fasting plasma glucose and glycosylated hemoglobin in the screening for diabetes mellitus after renal transplantation. Transplantation. 2009;88(3):429-34.
Valderhaug, T. G., Jenssen, T., Hartmann, A., Midtvedt, K., Holdaas, H., Reisaeter, A. V., & Hjelmesaeth, J. (2009). Fasting plasma glucose and glycosylated hemoglobin in the screening for diabetes mellitus after renal transplantation. Transplantation, 88(3), 429-34. https://doi.org/10.1097/TP.0b013e3181af1f53
Valderhaug TG, et al. Fasting Plasma Glucose and Glycosylated Hemoglobin in the Screening for Diabetes Mellitus After Renal Transplantation. Transplantation. 2009 Aug 15;88(3):429-34. PubMed PMID: 19667949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fasting plasma glucose and glycosylated hemoglobin in the screening for diabetes mellitus after renal transplantation. AU - Valderhaug,Tone G, AU - Jenssen,Trond, AU - Hartmann,Anders, AU - Midtvedt,Karsten, AU - Holdaas,Hallvard, AU - Reisaeter,Anna V, AU - Hjelmesaeth,Jøran, PY - 2009/8/12/entrez PY - 2009/8/12/pubmed PY - 2009/9/9/medline SP - 429 EP - 34 JF - Transplantation JO - Transplantation VL - 88 IS - 3 N2 - BACKGROUND: Fasting plasma glucose (fPG) is recommended to identify new-onset posttransplant diabetes mellitus (PTDM), but an oral glucose tolerance test (OGTT) has higher diagnostic sensitivity. We aimed to assess the accuracy of fPG and glycosylated hemoglobin (HbA1c) for the selection of patients who should undergo a diagnostic OGTT 10 weeks after renal transplantation. METHODS: A total of 1571 renal transplant recipients without prior diabetes underwent an OGTT 10 weeks after transplantation. Receiver operating characteristic analyses were used to identify optimal thresholds to incite further diagnostic tests. A sensitivity level of 80% was chosen for screening purpose. RESULTS: We diagnosed PTDM in 213 (14%) patients of whom 109 (51%) were identified by 2-hr plasma glucose more than or equal to 11.1 mmol/L alone, 35 (17%) by fPG alone, and 69 (32%) by both criteria. Receiver operating characteristic analysis revealed an area under the curve of 0.761 (95% confidence interval 0.714-0.809) for fPG and 0.817 (95% confidence interval 0.758-0.876) for HbA1c. Performing an OGTT on patients with an fPG more than or equal to 5.3 mmol/L or HbA1c more than or equal to 5.8% predicted diabetes with 81% and 83% sensitivity, requiring 49% and 41% of the patients to be tested, respectively. The combined criterion fPG more than or equal to 5.0 mmol/L and HbA1c more than or equal to 5.7%, provided a similar sensitivity (79%) from testing only 29% of the population. CONCLUSION: We conclude that patients with an fPG between 5.3 and 6.9 mmol/L or HbA1c more than or equal to 5.8%, alternatively an fPG more than or equal to 5.0 mmol/L combined with HbA1c more than or equal to 5.7% in the early posttransplant period should undergo an OGTT for diagnostic verification of PTDM. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/19667949/Fasting_plasma_glucose_and_glycosylated_hemoglobin_in_the_screening_for_diabetes_mellitus_after_renal_transplantation_ DB - PRIME DP - Unbound Medicine ER -