Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study

Pimentel, Ana Laura; Carvalho, Larissa Sant Anna Kellermann; Marques, Samara Silva; Franco, Rodrigo Fontanive; Silveiro, Sandra Pinho; Manfro, Roberto Ceratti; Camargo, Joíza Lins

doi:10.1016/j.cca.2015.03.016

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…The cumulative incidence of type 2 diabetes mellitus in the Norwegian general population is considerable lower than in most other European countries, which might be because of various dietary and life‐style factors, including lower sugar consumption . Interestingly, a low sensitivity of HbA1c for detection of PTDM early after renal transplantation has also been found in other population of RTRs with higher sugar consumption and PTDM incidence than in Norway . Furthermore, relatively low doses of immunosuppressive drugs as standard treatment at our centre in recent years might have contributed to lower the incidence of PTDM in Norwegian RTRs .…”

Section: Discussionmentioning

confidence: 83%

Mortality risk in post-transplantation diabetes mellitus based on glucose and HbA1c diagnostic criteria

et al. 2016

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Current diagnostic criteria for post-transplantation diabetes mellitus (PTDM) are either fasting plasma glucose ≥7.0 mmol/l (≥126 mg/dl) or postchallenge plasma glucose ≥11.1 mmol/l (≥200 mg/dl) 2 h after glucose administration [oral glucose tolerance test (OGTT) criterion]. In this retrospective cohort study of 1632 renal transplant recipients (RTRs) without known diabetes mellitus at the time of transplantation, we estimated mortality hazard ratios for patients diagnosed with PTDM by either conventional glucose criteria or the proposed glycated haemoglobin (HbA1c) criterion [HbA1c ≥6.5% (≥48 mmol/mol)]. During a median follow-up of 7.0 years, 311 patients died. Compared with nondiabetic patients and after adjustment for confounders, patients diagnosed with PTDM based on chronic hyperglycaemia early after transplantation (manifest PTDM) or by the OGTT criterion at 10 weeks post-transplant suffered a higher mortality risk (HR 1.59, 95% CI 1.06-2.38, P = 0.02 and HR 1.56, 95% CI 1.04-2.38, P = 0.03, respectively). In contrast, patients diagnosed with PTDM by the HbA1c criterion at 10 weeks or between 10 weeks and 1 year post-transplant were not associated with mortality (HR 0.96, 95% CI 0.61-1.51, P = 0.86 and 1.58, 95% CI 0.74-3.36, P = 0.24 respectively). After adjustment for confounders and competing risks, only patients with manifest PTDM had a significantly higher cardiovascular mortality risk (subdistributional HR 2.31, 95% CI 1.19-4.47, P < 0.001). Since many cases with PTDM were only identified by the OGTT, we recommend monitoring fasting plasma glucose early after renal transplantation followed by an OGTT at 2-3 months post-transplant in patients without overt diabetes mellitus.

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Section: Discussionmentioning

confidence: 83%

Mortality risk in post-transplantation diabetes mellitus based on glucose and HbA1c diagnostic criteria

et al. 2016

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“…The findings showed that HbA1c is a useful tool for the diagnosis of a previously undiagnosed DM in critically ill patients, and HbA1c at admission is significantly associated with intensive care unit mortality. Pimentel et al 50 have shown that HbA1c ≥6.5% is not enough to be used alone in the diagnosis of post-transplantation DM in renal transplant patients. However, the combined use of HbA1c cut-off points of ≤5.8% and ≥6.2% would reduce the number of oral glucose tolerance tests by 85% and the use of an algorithm with HbA1c in combination with FPG proved to be the most efficient strategy to diagnose or rule out post-transplantation DM.…”

Section: Prognostic Potentials Of Hba1cmentioning

confidence: 99%

“…However, the combined use of HbA1c cut-off points of ≤5.8% and ≥6.2% would reduce the number of oral glucose tolerance tests by 85% and the use of an algorithm with HbA1c in combination with FPG proved to be the most efficient strategy to diagnose or rule out post-transplantation DM. 50 Poor glycemic control (HbA1c ≥8%) has been associated with decreased survival in the general population of diabetic patients on maintenance hemodialysis, suggesting that moderate hyperglycemia increases the risk for all-cause mortality of diabetic maintenance hemodialysis patients in Han Chinese population. 51 Helminen et al 52 assessed the utility of HbA1c levels in predicting the clinical disease in genetically predisposed children with multiple autoantibodies.…”

Section: Prognostic Potentials Of Hba1cmentioning

confidence: 99%

Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients

et al. 2016

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Diabetes is a global endemic with rapidly increasing prevalence in both developing and developed countries. The American Diabetes Association has recommended glycated hemoglobin (HbA1c) as a possible substitute to fasting blood glucose for diagnosis of diabetes. HbA1c is an important indicator of long-term glycemic control with the ability to reflect the cumulative glycemic history of the preceding two to three months. HbA1c not only provides a reliable measure of chronic hyperglycemia but also correlates well with the risk of long-term diabetes complications. Elevated HbA1c has also been regarded as an independent risk factor for coronary heart disease and stroke in subjects with or without diabetes. The valuable information provided by a single HbA1c test has rendered it as a reliable biomarker for the diagnosis and prognosis of diabetes. This review highlights the role of HbA1c in diagnosis and prognosis of diabetes patients.

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“…Given that a certain proportion of patients is diagnosed solely via OGTT [48, 49], the incidence of PTDM and prediabetes might be even higher in our population. Diagnostic accuracy of HbA1c in chronic kidney disease [50] and after transplantation [51] is hampered by higher erythrocyte turnover, again underestimating the prevalence of disturbed glucose metabolism. Nonetheless, this is the first study to report long-term follow-up of glucose metabolism in individual patients after kidney transplantation in a large European cohort.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of Glucose Metabolism After Kidney Transplantation

Guthoff¹,

Wagner²,

Weichbrodt³

et al. 2017

Kidney Blood Press Res

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Background/Aims: Posttransplantation diabetes mellitus (PTDM) impacts patient and allograft survival after kidney transplantation. Prediabetes, which is an independent risk factor for PTDM, is modifiable also in a post-transplant setting. Understanding the risks and dynamics of impaired glucose metabolism after transplantation is a key component for targeted intervention. Methods: A retrospective chart analysis of all adult non-diabetic renal allograft recipients (n=251, 2007-2014) was performed. Longitudinal follow-up included fasting plasma glucose and HbA1c, as well as data on allograft function and immunosuppression at consecutive time points (months 3-6 to >5 years post transplantation). Results: Throughout follow-up, median prevalence of prediabetes and PTDM was 53.3 [52.4-55.7]% and 15.4 [15.0-16.5]%, respectively. Continuously high fluxes between states of glucose metabolism, with individual patients’ state deteriorating or improving over time, resulted in a high number of incident patients even long after transplantation. The greatest number of patients shifted between normal glucose tolerance and prediabetes, followed by those between prediabetes and PTDM. Conclusion: Prediabetes and PTDM are highly prevalent after kidney transplantation and incidences remain relevant throughout follow-up. Patient fluxes into and out of the prediabetic state show that glucose metabolism is highly dynamic after transplantation. This provides a continuous opportunity for intervention in an aim to reduce diabetes-associated complications.

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Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study

Cited by 10 publications

References 29 publications

Mortality risk in post-transplantation diabetes mellitus based on glucose and HbA1c diagnostic criteria

Mortality risk in post-transplantation diabetes mellitus based on glucose and HbA1c diagnostic criteria

Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients

Dynamics of Glucose Metabolism After Kidney Transplantation

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