title: Diagnostic Accuracies of Glycated Hemoglobin, Fructosamine, and Homeostasis Model Assessment of Insulin Resistance in Predicting Impaired Fasting Glucose, Impaired Glucose Tolerance, or New Onset Diabetes After Transplantation.
abstract: New onset diabetes after transplantation (NODAT) is associated with a 3-fold greater risk of cardiovascular disease events, with early identification and treatment potentially attenuating this risk. The optimal screening test to identify those with NODAT remains unclear, and the aim of this study was to examine the diagnostic accuracies of 4 screening tests in identifying impaired fasting glucose, impaired glucose tolerance (IGT), and NODAT.
  
  
  
  This is a single-center prospective cohort study of 83 nondiabetic kidney transplant recipients between 2008 and 2011. Oral glucose tolerance test was considered the gold standard in identifying IFG/IGT or NODAT. Diagnostic accuracies of random blood glucose, glycated hemoglobin (HBA1c), fructosamine, and Homeostasis Model Assessment-Insulin Resistance in predicting IFG/IGT or NODAT were assessed using the area under the receiver operating characteristic curve.
  
  
  
  Forty (48%) recipients had IFG/IGT or NODAT. Compared with HBA1c with adjusted area under the curve (AUC) of 0.88 (95% confidence interval [95% CI], 0.77-0.93), fructosamine was the most accurate test with adjusted AUC of 0.92 (95% CI, 0.83-0.96). The adjusted AUCs of random blood glucose and Homeostasis Model Assessment-Insulin Resistance in identifying IFG/IGT were between 0.81 and 0.85. Restricting to identifying IGT/NODAT using 2-hour oral glucose tolerance test (n = 66), fructosamine was the most accurate diagnostic test with adjusted AUC of 0.93 (95% CI, 0.84-0.99), but not statistically different to HBA1c with adjusted AUC of 0.88 (95% CI, 0.76-0.96).
  
  
  
  Although HBA1c is an acceptable and widely used screening test in detecting IFG/IGT or NODAT, fructosamine may be a more accurate diagnostic test but this needs to be further examined in larger cohorts.
authors.affiliation: 1 Department of Renal Medicine, Prince of Wales Hospital, Sydney, Australia. 2 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia. 3 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia. 4 PathWest, Sir Charles Gairdner Hospital, Perth, Australia. 5 Sydney School of Public Health, University of Sydney, New South Wales, Australia. 6 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia. 7 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.
authors.forename: Kerri
authors.initials: K
authors.lastname: Rosettenstein
authors.forename: Andrea
authors.initials: A
authors.lastname: Viecelli
authors.forename: Kenneth
authors.initials: K
authors.lastname: Yong
authors.forename: Hung Do
authors.initials: HD
authors.lastname: Nguyen
authors.forename: Aron
authors.initials: A
authors.lastname: Chakera
authors.forename: Doris
authors.initials: D
authors.lastname: Chan
authors.forename: Gursharan
authors.initials: G
authors.lastname: Dogra
authors.forename: Ee Mun
authors.initials: EM
authors.lastname: Lim
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D019270:Fructosamine / Q000032:analysis*; D018149:Glucose Intolerance / Q000097:blood; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006706:Homeostasis; D006801:Humans; D007165:Immunosuppression Therapy; D007333:Insulin Resistance; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications; D015203:Reproducibility of Results; D012306:Risk
chemical_list: D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin