Transplant Trial Watch

Criteria for prediabetes and posttransplant diabetes mellitus after kidney transplantation: A 2-year diagnostic accuracy study of participants from a randomized controlled trial.

Kurnikowski, A., et al.

American Journal of Transplantation 2022 [record in progress].


Aims
This post-hoc study aimed to investigate the diagnostic ability of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) against the oral glucose tolerance test (OGTT)-derived 2- hour plasma glucose (2hPG) in kidney transplant recipients (KTRs) from the Insulin Therapy for the Prevention of New Onset Diabetes After Transplantation study (ITP-NODAT).

Interventions
Participants in the ITP-NODAT trial were randomised to either the basal insulin intervention group or the standard-of-care group.

Participants
263 kidney transplant recipients (KTRs) from the ITP-NODAT trial.

Outcomes
The main outcomes of interest were the evolution of posttransplant diabetes mellitus (PTDM), diagnostic accuracy of HbA1c and FPG criteria for PTDM and impaired glucose tolerance (IGT), and relationship of fasting plasma glucose and HbA1c versus 2hPG.

Follow-up
24 months after transplantation.

CET Conclusions
This interesting post-hoc study investigates diagnostic parameters for post-transplant diabetes in a cohort of patients from the ITP-NODAT study. The authors demonstrate that around 1/3 of patients switch glycaemic category (normal/impaired glucose tolerance/diabetes) in the 2 years post-transplant. Use of conventional HbA1C or fasting glucose thresholds for diagnosis missed up to 69% cases diagnosed by a formal 2-hour oral glucose tolerance test (OGTT). There are some limitations to this post-hoc study, including a relatively small sample size with few patients with PTDM, and a lack of data on ethnicity. However, it does demonstrate the usefulness of a formal OGTT in diagnosing post-transplant diabetes.

Trial registration
ClinicalTrials.gov - NCT03507829

Funding source
Non-industry funded