The 5-time point oral glucose tolerance test as a predictor of new-onset diabetes after kidney transplantation.
OBJECTIVE
To evaluate the predictive power of the 5-time point oral glucose tolerance test (OGTT) for new-onset diabetes after kidney transplantation (NODAT).


METHODS
We performed a retrospective study of 145 patients without diabetes who received kidney transplantations at our hospital. The 5-time point OGTT was performed before transplantation. The area under a receiver-operating characteristic curve (aROC) was used for evaluating the predictive power of 5-time point OGTT values.


RESULTS
Seventeen patients developed NODAT within 1 year after transplantation. All postload plasma glucose (PPG) levels were higher in patients who developed NODAT than in those who did not; fasting plasma glucose levels were not different. The aROC for the area under the glucose concentration-time curve was significantly greater than that for fasting plasma glucose. Univariate and multivariate analyses showed that each PPG level was an independent risk factor for NODAT. Furthermore, patients with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) could be stratified with a 1-h plasma glucose (1h-PG) cut-off point of 8.4 mmol/L. The incidences of NODAT were 23.5%, 16.7%, 9.1%, and 0% for patients with IGT+1h-PG ≥8.4 mmol/L,IGT+1h-PG <8.4 mmol/L, NGT+1h-PG ≥ 8.4 mmol/L, and NGT+1h-PG<8.4 mmol/L, respectively.


CONCLUSIONS
The area under the glucose concentration-time curve and each PPG concentration during the 5-time point OGTT are strong predictors of NODAT. A 1h-PG cut-off point of 8.4 mmol/L plus NGT/IGT can be used to identify patients at intermediate and high risk of developing NODAT.
Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan 3-16-1 Tsutsumi-machi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan. Electronic address: tsu7ka5so8mi@yahoo.co.jp.
Kazuaki
K
Tokodai
Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan 3-16-1 Tsutsumi-machi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan.
Noritoshi
N
Amada
Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan 3-16-1 Tsutsumi-machi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan.
Izumi
I
Haga
Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan 3-16-1 Tsutsumi-machi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan.
Tetsuro
T
Takayama
Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan 3-16-1 Tsutsumi-machi, Aoba-ku, Sendai, Miyagi, 981-8501, Japan.
Atsushi
A
Nakamura
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology; D005215:Fasting; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis* / Q000209:etiology; D005951:Glucose Tolerance Test; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
D001786:Blood Glucose
Area under a glucose concentration-time curve; Five-time point oral glucose tolerance test; Kidney transplantation; New-onset diabetes after transplantation; Postload plasma glucose concentration/