Department of Health Policy, Harvard University, Cambridge, MA, USA.
Harvard Kennedy School, Harvard University, Cambridge, MA, USA.
Ann Transplant. 2021 Mar 16;26:e928624. doi: 10.12659/AOT.928624.
BACKGROUND New-onset diabetes after transplantation (NODAT) is a complication of solid organ transplantation. We sought to determine the extent to which NODAT goes undiagnosed over the course of 1 year following transplantation, analyze missed or later-diagnosed cases of NODAT due to poor hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) collection, and to estimate the impact that improved NODAT screening metrics may have on long-term outcomes. MATERIAL AND METHODS This was a retrospective study utilizing 3 datasets from a single center on kidney, liver, and heart transplantation patients. Retrospective analysis was supplemented with an imputation procedure to account for missing data and project outcomes under perfect information. In addition, the data were used to inform a simulation model used to estimate life expectancy and cost-effectiveness of a hypothetical intervention. RESULTS Estimates of NODAT incidence increased from 27% to 31% in kidney transplantation patients, from 31% to 40% in liver transplantation patients, and from 45% to 67% in heart transplantation patients, when HbA1c and FBG were assumed to be collected perfectly at all points. Perfect screening for kidney transplantation patients was cost-saving, while perfect screening for liver and heart transplantation patients was cost-effective at a willingness-to-pay threshold of $100 000 per life-year. CONCLUSIONS Improved collection of HbA1c and FBG is a cost-effective method for detecting many additional cases of NODAT within the first year alone. Additional research into both improved glucometric monitoring as well as effective strategies for mitigating NODAT risk will become increasingly important to improve health in this population.
移植后新发糖尿病（NODAT）是实体器官移植的一种并发症。我们旨在确定在移植后 1 年内，NODAT 未被诊断的程度，分析因糖化血红蛋白（HbA1c）和空腹血糖（FBG）采集不佳而导致的漏诊或迟诊 NODAT 病例，并评估改善 NODAT 筛查指标对长期结果的影响。
这是一项回顾性研究，利用了来自单一中心的 3 个数据集，包括肾、肝和心脏移植患者。回顾性分析辅以插补程序，以弥补缺失数据并根据完美信息预测结果。此外，还利用这些数据来构建一个模拟模型，用于估计一种假设干预措施的预期寿命和成本效益。
当假设 HbA1c 和 FBG 在所有时间点都被完美采集时，肾移植患者的 NODAT 发病率从 27%增加到 31%，肝移植患者从 31%增加到 40%，心脏移植患者从 45%增加到 67%。对于肾移植患者，完美筛查可节省成本，而对于肝和心脏移植患者，当每例生命年支付意愿阈值为 10 万美元时，完美筛查具有成本效益。
HbA1c 和 FBG 采集的改善是在第一年仅通过检测更多的 NODAT 病例而具有成本效益的方法。对改进血糖监测以及减轻 NODAT 风险的有效策略的进一步研究，对于改善该人群的健康状况将变得越来越重要。
