Eleftheriadis Georgios, Naik Marcel G, Osmanodja Bilgin, Liefeldt Lutz, Halleck Fabian, Choi Mira, Schrezenmeier Eva, Zukunft Bianca, Tura Andrea, Budde Klemens
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
CNR Institute of Neuroscience, Padova, Italy.
Transpl Int. 2024 Nov 15;37:13724. doi: 10.3389/ti.2024.13724. eCollection 2024.
Post-transplantation diabetes mellitus (PTDM) and prediabetes are associated with increased cardiovascular morbidity and mortality in kidney transplant recipients (KTR), when diagnosed by an oral glucose tolerance test (oGTT). Hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) display low concordance with the oGTT in the early phase posttransplant. For this prospective cross-sectional pilot study, 41 KTR from years one to five after transplantation without known preexisting PTDM (defined by HbA1c ≥ 6.5% (NGSP) or 48 mmol/mol (IFCC) at last visit or glucose-lowering therapy) were recruited at the Charité Transplant Outpatient Clinic. For each study participant HbA1c, FPG and an oGTT were followed by CGM. 38 of the 41 patients recruited had sufficient CGM-recordings (≥10 days). PTDM and impaired glucose tolerance (IGT), as defined by the gold standard oral glucose tolerance test (oGTT)-derived 2-h plasma glucose (2hPG), were diagnosed in one (3%) and twelve (32%) patients, respectively. HbA1c exhibited good test characteristics regarding IGT (ROC-AUC: 0.87); sensitivity/specificity of HbA1c-threshold 5.7% (NGSP) or 39 mmol/mol (IFCC) were 1.0/0.64, respectively. Best performing CGM-readouts mean sensor glucose and percent of time >140 mg/dL (%TAR (140 mg/dL)) displayed acceptable diagnostic performance (ROC-AUC: 0.78 for both). Thus, HbA1c can aid in timely diagnosis of IGT in the stable phase after kidney transplantation.
通过口服葡萄糖耐量试验（oGTT）诊断时，移植后糖尿病（PTDM）和糖尿病前期与肾移植受者（KTR）心血管疾病发病率和死亡率的增加相关。在移植后的早期阶段，糖化血红蛋白（HbA1c）和空腹血糖（FPG）与oGTT的一致性较低。在这项前瞻性横断面试点研究中，从Charité移植门诊招募了41名移植后1至5年且无已知既往PTDM（根据末次就诊时HbA1c≥6.5%（NGSP）或48 mmol/mol（IFCC）或降糖治疗定义）的KTR。对每位研究参与者进行HbA1c、FPG检测，并在之后进行连续血糖监测（CGM）。招募的41名患者中有38名有足够的CGM记录（≥10天）。根据金标准口服葡萄糖耐量试验（oGTT）得出的2小时血浆葡萄糖（2hPG）定义，分别有1名（3%）和12名（32%）患者被诊断为PTDM和糖耐量受损（IGT）。HbA1c在IGT方面表现出良好的检测特性（ROC曲线下面积：0.87）；HbA1c阈值为5.7%（NGSP）或39 mmol/mol（IFCC）时的敏感性/特异性分别为1.0/0.64。表现最佳的CGM读数，即平均传感器葡萄糖和血糖>140 mg/dL的时间百分比（%TAR（140 mg/dL））显示出可接受的诊断性能（两者的ROC曲线下面积均为0.78）。因此，HbA1c有助于在肾移植后的稳定期及时诊断IGT。
