The 5-time point oral glucose tolerance test as a predictor of new-onset diabetes after kidney transplantation

Tokodai, Kazuaki; Amada, Noritoshi; Haga, Izumi; Takayama, Tetsuro; Nakamura, Atsushi

doi:10.1016/j.diabres.2013.12.049

Cited by 14 publications

(11 citation statements)

References 31 publications

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“…Once more, consistent with findings in the general population, the authors also identified that nondiabetic patients with higher 1 hour oGTT had increased risk of PTDM. 36 Although we are limited by our small sample size, our similar findings may indicate subclinical pretransplant β cell susceptibility, which fails under the stressors of transplantation. Despite different groups demonstrating potential susceptibility by oGTT testing, we and others 5 have not been able to identify pretransplant pathophysiological changes that may account for this susceptibility.…”

Section: Discussionmentioning

confidence: 55%

A Prospective Study of Renal Transplant Recipients: A Fall in Insulin Secretion Underpins Dysglycemia After Renal Transplantation

Langsford

Obeyesekere

Vogrin

et al. 2016

Transplantation Direct

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BackgroundDysglycemia (encompassing impaired glucose tolerance and diabetes mellitus) arising after renal transplantation is common and confers a significant cardiovascular mortality risk. Nonetheless, the pathophysiology of posttransplant dysglycemia is not well described. The aim of this study was to prospectively and comprehensively assess glucose handling in renal transplant recipients from before to 12 months after transplantation to determine the underpinning pathophysiology.Materials and MethodsIntravenous and oral glucose tolerance testing was conducted before and at 3 and 12 months posttransplantation. An intravenous glucose tolerance test was also performed on day 7 posttransplantation. We followed up 16 transplant recipients for 3 months and 14 recipients for 12 months. Insulin secretion, resistance and a disposition index (DI (IV)), a measure of β cell responsiveness in the context of prevailing insulin resistance, were also determined.ResultsAt 12 months, 50% of renal transplant recipients had dysglycemia. Dysglycemia was associated with a dramatic fall in DI (IV) and this loss in β cell function was evident as early as 3 months posttransplantation (23.5 pretransplant; 6.4 at 3 months and 12.2 at 12 months posttransplant). Differences in the β cell response to oral glucose challenge were evident pretransplant in those destined to develop dysglycemia posttransplant (2-hour blood glucose level 5.6 mmol/L versus 6.8 mmol/L; P < 0.01).ConclusionsDysglycemia after renal transplantation is common, and the loss of insulin secretion is a major contributor. Subclinical differences in glucose handling are evident pretransplant in those destined to develop dysglycemia potentially heralding a susceptible β cell which under the stressors associated with transplantation fails.

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Section: Discussionmentioning

confidence: 55%

A Prospective Study of Renal Transplant Recipients: A Fall in Insulin Secretion Underpins Dysglycemia After Renal Transplantation

Langsford

Obeyesekere

Vogrin

et al. 2016

Transplantation Direct

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“…As the predictive value of fasting plasma glucose for the development of type 2 diabetes remains controversial [32, 33], its predictive value for NODAT development needs to be further investigated. Hepatitis C virus (HCV) infection is also an important risk factor of the development of type 2 diabetes, as we have previously reported [12]. In this study, however, only 3 of the 119 patients had HCV infections; hence, the association between HCV infections and NODAT development could not be statistically investigated.…”

Section: Discussionmentioning

confidence: 74%

“…Both the studies excluded recipients aged < 18 years and included recipients with similar baseline characteristics, including equivalent age, sex, and pretransplant HbA1c level. The major difference between these two studies was the study design: our study excluded patients who had received a cyclosporine-based immunosuppressive regimen because our previous study had showed that all patients who developed NODAT had received a tacrolimus-based immunosuppressive regimen [12]. Furthermore, in our study, the incidence rate of NODAT development was lower (14.3%) than that in Tatar's study (25.9%), and pretransplant BMI and fasting plasma glucose levels were not associated with NODAT development.…”

Section: Discussionmentioning

confidence: 99%

Pretransplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin

Tokodai

Amada

Haga

et al. 2014

International Journal of Endocrinology

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Aims. To evaluate the predictive power of pretransplant HbA1c for new-onset diabetes after transplantation (NODAT) in kidney transplant candidates, who had several predispositions for fluctuated HbA1c levels. Methods. We performed a retrospective study of 119 patients without diabetes who received kidney transplantation between March 2000 and January 2012. Univariate and multivariate logistic regression analyses were used to investigate the association of several parameters with NODAT. Predictive discrimination of HbA1c was assessed using a receiver-operating characteristic curve. Results. Seventeen patients (14.3%) developed NODAT within 1 year of transplantation. Univariate logistic regression analysis revealed that recipient age, gender, and HbA1c were predictors of NODAT. In the multivariate analysis, the association between pretransplant HbA1c and NODAT development did not reach statistical significance (P = 0.07). To avoid the strong influence of high-dose erythropoietin on HbA1c levels, we performed subgroup analyses on 85 patients receiving no or low-dose (≤6000 IU/week) erythropoietin. HbA1c was again an independent predictor for NODAT. Receiver-operating characteristic analysis revealed a cut-off value of 5.2% with an optimal sensitivity of 64% and specificity of 78% for predicting NODAT. Conclusions. Our results reveal that the pretransplant HbA1c level is a useful predictor for NODAT in patients receiving no or low-dose erythropoietin.

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“…Both the studies excluded recipients aged < 18 years and included recipients with similar baseline characteristics, including equivalent age, sex, and pretransplant HbA1c level. The major difference between these two studies was the study design: our study excluded patients who had received a cyclosporine-based immunosuppressive regimen because our previous study had showed that all patients who developed NODAT had received a tacrolimusbased immunosuppressive regimen [12]. Furthermore, in our study, the incidence rate of NODAT development was lower (14.3%) than that in Tatar's study (25.9%), and pretransplant BMI and fasting plasma glucose levels were not associated with NODAT development.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we have recently reported that OGTT can be a useful predictor of NODAT development [12]. However, OGTT is time consuming and forces patients to fast overnight.…”

Section: Introductionmentioning

confidence: 99%

Pre-Transplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin.

et al. 2014

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Aims. To evaluate the predictive power of pretransplant HbA1c for new-onset diabetes after transplantation (NODAT) in kidney transplant candidates, who had several predispositions for fluctuated HbA1c levels. Methods. We performed a retrospective study of 119 patients without diabetes who received kidney transplantation between March 2000 and January 2012. Univariate and multivariate logistic regression analyses were used to investigate the association of several parameters with NODAT. Predictive discrimination of HbA1c was assessed using a receiver-operating characteristic curve. Results. Seventeen patients (14.3%) developed NODAT within 1 year of transplantation. Univariate logistic regression analysis revealed that recipient age, gender, and HbA1c were predictors of NODAT. In the multivariate analysis, the association between pretransplant HbA1c and NODAT development did not reach statistical significance ( = 0.07). To avoid the strong influence of high-dose erythropoietin on HbA1c levels, we performed subgroup analyses on 85 patients receiving no or low-dose (≤6000 IU/week) erythropoietin. HbA1c was again an independent predictor for NODAT. Receiver-operating characteristic analysis revealed a cut-off value of 5.2% with an optimal sensitivity of 64% and specificity of 78% for predicting NODAT. Conclusions. Our results reveal that the pretransplant HbA1c level is a useful predictor for NODAT in patients receiving no or low-dose erythropoietin.

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The 5-time point oral glucose tolerance test as a predictor of new-onset diabetes after kidney transplantation

Cited by 14 publications

References 31 publications

A Prospective Study of Renal Transplant Recipients: A Fall in Insulin Secretion Underpins Dysglycemia After Renal Transplantation

A Prospective Study of Renal Transplant Recipients: A Fall in Insulin Secretion Underpins Dysglycemia After Renal Transplantation

Pretransplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin

Pre-Transplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin.

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