Laboratory for Renal Physiology, Section for Nephrology, Department of Medicine, Oslo University Hospital Rikshospitalet, 0027 Oslo, Norway.
Clin J Am Soc Nephrol. 2010 Apr;5(4):616-22. doi: 10.2215/CJN.07501009. Epub 2010 Feb 4.
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.
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.
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).
指南建议，对于空腹血糖（FPG）<110mg/dl（<6.1mmol/L）且无糖尿病的肾移植（KTx）候选者，在移植前应进行口服葡萄糖耐量试验（OGTT）；然而，OGTT 可能既昂贵又繁琐。我们研究了 OGTT 对诊断糖尿病的作用，以及 FPG 和糖化血红蛋白（HbA（1c））预测 KTx 前糖尿病 OGTT 的准确性。
设计、地点、参与者和测量：在这项横断面研究中，889 名无糖尿病的首次单肾移植候选者在移植评估期间进行了 OGTT。使用受试者工作特征分析研究结果。
在 72 名（8.1%）未确诊糖尿病的患者中，只有 16 名（22%）的 FPG 升高（>或=126mg/dl（>或=7.0mmol/L））。在 FPG 正常的患者中，糖尿病（2 小时血糖[2h-PG]>或=200mg/dl（>或=11.1mmol/L））可通过 FPG 预测，但不能通过 HbA（1c）预测。在 FPG 为 92 至 125mg/dl（5.1 至 6.9mmol/L）的患者中进行 OGTT 可发现 65 名（90%）糖尿病患者（16 名通过 FPG，49 名通过 2h-PG），每位患者需进行 7 次 OGTT。对所有 FPG<110mg/dl（<6.1mmol/L）的患者进行 OGTT 可发现 60 名（83%）糖尿病患者（16 名通过 FPG，44 名通过 2h-PG），但每位患者需进行 14 次 OGTT。
OGTT 是在 KTx 前发现大多数未确诊糖尿病病例的关键。FPG 但不是 HbA（1c）可预测糖尿病 OGTT。我们建议，无糖尿病的白人 KTx 候选者在 FPG 为 92 至 125mg/dl（5.1 至 6.9mmol/L）时进行移植前 OGTT。
