title: Diagnostic accuracy of glycated hemoglobin for post-transplantation diabetes mellitus after kidney transplantation: systematic review and meta-analysis.
abstract: Early detection of post-transplantation diabetes mellitus (PTDM) allows prompt clinical and pharmacological interventions, reducing the chance of adverse outcomes. We conducted a systematic review and meta-analysis to determine the overall diagnostic accuracy of glycated hemoglobin (HbA1c) for the diagnosis of renal PTDM.
  
  
  
  We searched MEDLINE, Embase and SCOPUS up to June 2016. Studies that included adults without previous diabetes were selected if they reported an oral glucose tolerance test as a reference test, HbA1c levels measured by standardized methods and data necessary for drawing 2 × 2 tables. A bivariate model was used to calculate the pooled estimates.
  
  
  
  Based on 2057 kidney recipients from six studies, an HbA1c cut-off point of 6.5% in early months after transplant resulted in sensitivity of 0.48 [95% confidence interval (95% CI) 0.31-0.65], specificity of 0.96 (95% CI 0.95-0.97), positive likelihood ratio (PLR) of 12.0 (95% CI 7.4-19.5) and negative likelihood ratio (NLR) of 0.54 (95% CI 0.38-0.77). Based on 1888 kidney recipients from four studies, an HbA1c cut-off point of 6.2% early after transplant resulted in sensitivity of 0.76 (95% CI 0.49-0.91), specificity of 0.89 (95% CI 0.86-0.92), PLR of 7.18 (95% CI 5.29-9.75) and NLR of 0.27 (95% CI 0.11-0.65).
  
  
  
  HbA1c cut-off points of 6.5% and 6.2% presented high specificity but low/moderate sensitivity to diagnose PTDM.
authors.affiliation: Graduate Programme in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: Ana Laura
authors.initials: AL
authors.lastname: Pimentel
authors.affiliation: Graduate Programme in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.|Centro Universitário FSG, Caxias do Sul, Brazil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Cavagnolli
authors.affiliation: Graduate Programme in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.|Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Joíza Lins
authors.initials: JL
authors.lastname: Camargo
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D016572:Cyclosporine / Q000009:adverse effects; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000175:diagnosis* / Q000378:metabolism; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis* / Q000378:metabolism; D012680:Sensitivity and Specificity; D016559:Tacrolimus / Q000009:adverse effects
chemical_list: D000305:Adrenal Cortex Hormones; D016572:Cyclosporine; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; D016559:Tacrolimus; C517652:hemoglobin A1c protein, human
keywords: HbA1c; PTDM; diagnosis; kidney transplantation; meta-analysis