Post-Transplant Diabetes Can Be Predicted in Kidney Recipients

Marlene Busko, for Medscape

September 27, 2022

Researchers published the study covered in this summary on Research Square and it has not yet been peer reviewed.

Key Takeaways

  • A retrospective, case-control study of kidney transplant recipients in China identified that a combination of the following parameters can predict post-transplant diabetes mellitus (PTDM) diagnosed after 45 days:

    • Family history of diabetes mellitus.

    • Standard deviation of fasting plasma glucose when values are fluctuating (day 3 to day 11 post-transplant).

    • Maximum fasting plasma glucose when values have stabilized (week 3 to week 6 post-transplant).

  • The combined parameters have good sensitivity and specificity and possible potential for routine clinical use.

  • Glycated albumin was not a good independent predictor of PTDM.

Why This Matters

  • Approximately 10% to 20% of kidney transplant recipients develop PTDM 3 months after transplant, and 70% of these patients have persistent diabetes and are at high risk of cardiovascular morbidity, infections, graft failure, and earlier mortality.

  • There is a need for a better predictor of PTDM because kidney transplant recipients should not have an oral glucose tolerance test 4 to 12 months after transplant due to potential harm to the graft, and A1c is not sensitive enough to reflect glycemic fluctuations and would give a biased positive prediction due to the high rate of anemia (70% to 80%) in kidney transplant recipients.

  • Patients may benefit from early prediction of PTDM because interventions and/or treatments could be implemented to reduce the risk of long-term consequences of poorly managed diabetes.

Study Design

  • The researchers performed a retrospective review of electronic health record data of patients aged 15 to 65 who had a kidney transplant at their center from January 2017 to December 2018 and who did not have diabetes before transplant, or a multiorgan transplant, or graft loss or death before PTDM diagnosis, but who did have in-hospital fasting plasma glucose and glycated albumin data, and 1-year follow-up.

  • PTDM was diagnosed according to the 2014 World Health Organization definition of hyperglycemia: plasma glucose ≥ 7.0 mmol/L on more than one occasion, random plasma glucose ≥ 11.1 mmol/L, oral glucose tolerance test 2-hour glucose ≥ 11.1 mmol/L, and A1c ≥ 6.5%, after day 45 following a kidney transplant.

  • The study aimed to explore whether glycated albumin or fasting plasma glucose, both routinely monitored during a patient's hospital stay, could be used to predict PTDM diagnosed from day 45 post-operation to 1 year.

  • The researchers compared fasting plasma glucose and glycated albumin values in the PTDM and non-PTDM groups in the fluctuation and stable periods.

Key Results

  • Of the 536 patients who had a kidney transplant, 38 patients developed PTDM and 498 patients did not.

  • Compared to patients who did not develop PTDM, those who did were older (median age 42 vs 32) and had a higher rate of smoking, higher preoperative creatinine, and higher rate of family history of diabetes mellitus (all P < .05). There were more males in the PTDM group (82% vs 69%), but this was not a significant difference.

  • In multivariate logistic regression, the following three variables predicted PTDM:

    • Family history of diabetes mellitus (odds ratio [OR] 3.21; 95% CI, 1.09 - 9.47; P = .035).

    • Standard deviation of fasting plasma glucose > 2.09 mmol/L in the fluctuation period after the kidney transplant (OR, 3.06; 95% CI, 1.50 - 6.22; P = .002).

    • Maximum fasting plasma glucose > 5.08 mmol/L in the stable period after kidney transplant (OR, 6.85; 95% CI, 3.32 - 14.13; P < .001).

  • A combination of these three variables had better discrimination in predicting PTDM (area under the curve [AUC] = 0.81; sensitivity = 73.7%; specificity = 76.3%) compared with each variable alone (P < .05).

  • Mean, maximum, minimum, and median glycated albumin levels in the fluctuation period after transplant predicted PTDM (AUC, 0.61-0.63), but this parameter cannot be used as an independent predictor in logistic regression.

Limitations

  • This was a retrospective study with a relatively small sample, so further study is needed to confirm the findings.

Disclosures

  • The study did not receive commercial funding.

  • The authors have reported no financial disclosures related to this research.

This is a summary of a preprint article "Postoperative fasting plasma glucose and family history diabetes mellitus can predict post-transplantation diabetes mellitus in kidney transplant recipients" written by researchers from First Affiliated Hospital of Xi'an Jiaotong University, China. Preprints from Research Square are provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on Research Square.

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