Should an oral glucose tolerance test be performed routinely in all renal transplant recipients?

Armstrong, Kirsten A., Prins, Johannes B., Beller, Elaine M., Campbell, Scott B., Hawley, Carmel M., Johnson, David W. and Isbel, Nicole M. (2006) Should an oral glucose tolerance test be performed routinely in all renal transplant recipients?. Clinical Journal of The American Society of Nephrology, 1 1: 100-108. doi:10.2215/CJN.00090605


Author Armstrong, Kirsten A.
Prins, Johannes B.
Beller, Elaine M.
Campbell, Scott B.
Hawley, Carmel M.
Johnson, David W.
Isbel, Nicole M.
Title Should an oral glucose tolerance test be performed routinely in all renal transplant recipients?
Journal name Clinical Journal of The American Society of Nephrology   Check publisher's open access policy
ISSN 1555-9041
1555-905X
Publication date 2006-01
Sub-type Article (original research)
DOI 10.2215/CJN.00090605
Volume 1
Issue 1
Start page 100
End page 108
Total pages 9
Editor W. M. Bennett
Place of publication Washington DC, United States
Publisher American Society Nephrology
Collection year 2006
Language eng
Subject C1
730106 Cardiovascular system and diseases
730305 Diagnostic methods
110312 Nephrology and Urology
110201 Cardiology (incl. Cardiovascular Diseases)
Abstract Posttransplantation diabetes (PTD) contributes to cardiovascular disease and graft loss in renal transplant recipients (RTR). Current recommendations advise fasting blood glucose (FBG) as the screening and diagnostic test of choice for PTD. This study sought to determine (1) the predictive power of FBG with respect to 2-h blood glucose (2HBG) and (2) the prevalence of PTD using FBG and 2HBG compared with that using FBG alone, in prevalent RTR. A total of 200 RTR (mean age 52 yr; 59% male; median transplant duration 6.6 yr) who were >6 mo posttransplantation and had no known history of diabetes were studied. Patients with FBG <126 mg/dl (7.0 mmol/L; n = 188) underwent an oral glucose tolerance test (OGTT). Receiver operating characteristic analyses evaluated the optimal level of FBG predictive of PTD (2HBG :200 mg/dl [11.1 mmol/L]) and impaired glucose tolerance (IGT; 2HBG 140 to 200 mg/dl [7.8 to 11.0 mmol/L]). An abnormal OGTT was reported in 79 (42%) nondiabetic RTR: PTD (n = 22) and IGT (n = 57). The optimal FBG that was predictive of PTD was 101 mg/dl (5.6 mmol/L; area under the curve 0.70; sensitivity 64%, specificity 67%, positive predictive value 20%, negative predictive value 93%). The optimal FBG that was predictive of IGT was less well defined (area under the curve 0.54). The prevalence of PTD was higher by OGTT than by FBG alone (17 versus 6%; P < 0.001). FBG may not be the optimal screening or diagnostic tool for PTD or IGT in RTR. Consideration should be given to introducing the OGTT as a routine posttransplantation investigation, although the implications of a pathologic OGTT are still to be determined in this population.
Keyword Urology & Nephrology
Onset Diabetes mellitus
Impaired Fasting Glucose
Risk-factors
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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Created: Wed, 15 Aug 2007, 09:47:15 EST