Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study
The role of glycated hemoglobin (A1C) in the screening and diagnosis of posttransplantation diabetes mellitus (PTDM) is still not entirely understood. We evaluated the use of A1C test in renal transplant recipients at four months after transplantation. A total of 122 out of 274 patients without prev...
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| Veröffentlicht in: | Clinica chimica acta 2015-05, Vol.445, p.48-53 |
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| creator | Pimentel, Ana Laura Carvalho, Larissa Sant Anna Kellermann Marques, Samara Silva Franco, Rodrigo Fontanive Silveiro, Sandra Pinho Manfro, Roberto Ceratti Camargo, Joíza Lins |
| description | The role of glycated hemoglobin (A1C) in the screening and diagnosis of posttransplantation diabetes mellitus (PTDM) is still not entirely understood. We evaluated the use of A1C test in renal transplant recipients at four months after transplantation.
A total of 122 out of 274 patients without previous diabetes that underwent kidney transplantation were enrolled. ROC curve was used to analyze the performance of A1C to diagnose PTDM considering OGTT as the reference standard.
OGTT identified 32 (26.2%) patients with PTDM, whereas A1C≥6.5% (48mmol/mol) identified only 16 patients. A1C showed moderate accuracy to detect PTDM in the ROC curve [AUC 0.832 (95% CI 0.740–0.924, p |
| doi_str_mv | 10.1016/j.cca.2015.03.016 |
| format | Article |
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A total of 122 out of 274 patients without previous diabetes that underwent kidney transplantation were enrolled. ROC curve was used to analyze the performance of A1C to diagnose PTDM considering OGTT as the reference standard.
OGTT identified 32 (26.2%) patients with PTDM, whereas A1C≥6.5% (48mmol/mol) identified only 16 patients. A1C showed moderate accuracy to detect PTDM in the ROC curve [AUC 0.832 (95% CI 0.740–0.924, p<0.001)]. A1C of 5.8% (40mmol/mol) was the equilibrium point (sensitivity 75% and specificity 72.2%) and A1C≥6.2% (44mmol/mol) showed high specificity of 93.3%.
A1C≥6.5% (48mmol/mol) is not enough to be used alone in the diagnosis of PTDM. The combined use of A1C cut-off points of ≤5.8% (40mmol/mol) and ≥6.2% (44mmol/mol) would reduce the number of OGTT by 85%. The use of an algorithm with A1C test in combination with FPG and/or 2h-PG proved to be the most efficient strategy to diagnose or rule out PTDM.
•The performance of A1c to detect PTDM was evaluated in 122 patients that underwent kidney transplantation.•A1c ≥6.5% (48mmol/mol) is not enough to be used alone in the diagnosis of PTDM.•A1c ≤5.8% (40mmol/mol) presented adequate sensitivity to rule out PTDM.•A1c ≥6.2% (44mmol/mol) showed excellent specificity to rule in PTDM.•A1c test in combination with OGTT proved to be the most efficient alternative strategy to exclude or confirm PTDM.</description><identifier>ISSN: 0009-8981</identifier><identifier>EISSN: 1873-3492</identifier><identifier>DOI: 10.1016/j.cca.2015.03.016</identifier><identifier>PMID: 25797896</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>A1C ; Adult ; Aged ; Biomarkers - blood ; Blood Glucose - metabolism ; Cross-Sectional Studies ; Diabetes Mellitus - blood ; Diabetes Mellitus - diagnosis ; Diabetes Mellitus - etiology ; Diabetes Mellitus - pathology ; Diagnostic accuracy ; Female ; Glucose Tolerance Test ; Glycated hemoglobin ; Glycated Hemoglobin A - metabolism ; Humans ; Kidney - metabolism ; Kidney - pathology ; Kidney Transplantation - adverse effects ; Male ; Middle Aged ; Posttransplantation diabetes mellitus ; PTDM ; Renal transplantation ; ROC Curve</subject><ispartof>Clinica chimica acta, 2015-05, Vol.445, p.48-53</ispartof><rights>2015 Elsevier B.V.</rights><rights>Copyright © 2015 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-4f85ae257b6c443366f2c6bae7a62207aa6c1aff15ac2f8235d41733a6903d213</citedby><cites>FETCH-LOGICAL-c353t-4f85ae257b6c443366f2c6bae7a62207aa6c1aff15ac2f8235d41733a6903d213</cites><orcidid>0000-0003-3163-2097</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.cca.2015.03.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25797896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pimentel, Ana Laura</creatorcontrib><creatorcontrib>Carvalho, Larissa Sant Anna Kellermann</creatorcontrib><creatorcontrib>Marques, Samara Silva</creatorcontrib><creatorcontrib>Franco, Rodrigo Fontanive</creatorcontrib><creatorcontrib>Silveiro, Sandra Pinho</creatorcontrib><creatorcontrib>Manfro, Roberto Ceratti</creatorcontrib><creatorcontrib>Camargo, Joíza Lins</creatorcontrib><title>Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study</title><title>Clinica chimica acta</title><addtitle>Clin Chim Acta</addtitle><description>The role of glycated hemoglobin (A1C) in the screening and diagnosis of posttransplantation diabetes mellitus (PTDM) is still not entirely understood. We evaluated the use of A1C test in renal transplant recipients at four months after transplantation.
A total of 122 out of 274 patients without previous diabetes that underwent kidney transplantation were enrolled. ROC curve was used to analyze the performance of A1C to diagnose PTDM considering OGTT as the reference standard.
OGTT identified 32 (26.2%) patients with PTDM, whereas A1C≥6.5% (48mmol/mol) identified only 16 patients. A1C showed moderate accuracy to detect PTDM in the ROC curve [AUC 0.832 (95% CI 0.740–0.924, p<0.001)]. A1C of 5.8% (40mmol/mol) was the equilibrium point (sensitivity 75% and specificity 72.2%) and A1C≥6.2% (44mmol/mol) showed high specificity of 93.3%.
A1C≥6.5% (48mmol/mol) is not enough to be used alone in the diagnosis of PTDM. The combined use of A1C cut-off points of ≤5.8% (40mmol/mol) and ≥6.2% (44mmol/mol) would reduce the number of OGTT by 85%. The use of an algorithm with A1C test in combination with FPG and/or 2h-PG proved to be the most efficient strategy to diagnose or rule out PTDM.
•The performance of A1c to detect PTDM was evaluated in 122 patients that underwent kidney transplantation.•A1c ≥6.5% (48mmol/mol) is not enough to be used alone in the diagnosis of PTDM.•A1c ≤5.8% (40mmol/mol) presented adequate sensitivity to rule out PTDM.•A1c ≥6.2% (44mmol/mol) showed excellent specificity to rule in PTDM.•A1c test in combination with OGTT proved to be the most efficient alternative strategy to exclude or confirm PTDM.</description><subject>A1C</subject><subject>Adult</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Blood Glucose - metabolism</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - diagnosis</subject><subject>Diabetes Mellitus - etiology</subject><subject>Diabetes Mellitus - pathology</subject><subject>Diagnostic accuracy</subject><subject>Female</subject><subject>Glucose Tolerance Test</subject><subject>Glycated hemoglobin</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Humans</subject><subject>Kidney - metabolism</subject><subject>Kidney - pathology</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Posttransplantation diabetes mellitus</subject><subject>PTDM</subject><subject>Renal transplantation</subject><subject>ROC Curve</subject><issn>0009-8981</issn><issn>1873-3492</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFq3DAQhkVpaTZpH6CXomMvdiXLlu32FELaFAKB0p7FWBpttNjSVpID-y552GjZpIceCgPDDN__M8NPyAfOas64_LyrtYa6YbyrmajL5hXZ8KEXlWjH5jXZMMbGahgHfkbOU9qVsWWSvyVnTdeP_TDKDXn8GWakwdLtfNCQ0dB7XMJ2DpPztFS-R5p0RPTObyl4Q42DrQ_JpaNqH1LOEXzaz-AzZBf8EZgwY6ILzrPLa6JgM0Ya0cNM_6G_0MsXx-w0Ba3XCPpAU17N4R15Y2FO-P65X5Df365_Xd1Ut3fff1xd3lZadCJXrR06wPLTJHXbCiGlbbScAHuQTcN6AKk5WMs70I0dGtGZlvdCgByZMA0XF-TTyXcfw58VU1aLS7pcDx7DmhSXvRQt5-NYUH5CdQwpRbRqH90C8aA4U8dQ1E6VUNQxFMWEKpui-fhsv04Lmr-KlxQK8PUEYHnywWFUSTv0Go2LqLMywf3H_gk8r6Ct</recordid><startdate>20150520</startdate><enddate>20150520</enddate><creator>Pimentel, Ana Laura</creator><creator>Carvalho, Larissa Sant Anna Kellermann</creator><creator>Marques, Samara Silva</creator><creator>Franco, Rodrigo Fontanive</creator><creator>Silveiro, Sandra Pinho</creator><creator>Manfro, Roberto Ceratti</creator><creator>Camargo, Joíza Lins</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3163-2097</orcidid></search><sort><creationdate>20150520</creationdate><title>Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study</title><author>Pimentel, Ana Laura ; Carvalho, Larissa Sant Anna Kellermann ; Marques, Samara Silva ; Franco, Rodrigo Fontanive ; Silveiro, Sandra Pinho ; Manfro, Roberto Ceratti ; Camargo, Joíza Lins</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-4f85ae257b6c443366f2c6bae7a62207aa6c1aff15ac2f8235d41733a6903d213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>A1C</topic><topic>Adult</topic><topic>Aged</topic><topic>Biomarkers - blood</topic><topic>Blood Glucose - metabolism</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes Mellitus - blood</topic><topic>Diabetes Mellitus - diagnosis</topic><topic>Diabetes Mellitus - etiology</topic><topic>Diabetes Mellitus - pathology</topic><topic>Diagnostic accuracy</topic><topic>Female</topic><topic>Glucose Tolerance Test</topic><topic>Glycated hemoglobin</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Humans</topic><topic>Kidney - metabolism</topic><topic>Kidney - pathology</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Posttransplantation diabetes mellitus</topic><topic>PTDM</topic><topic>Renal transplantation</topic><topic>ROC Curve</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pimentel, Ana Laura</creatorcontrib><creatorcontrib>Carvalho, Larissa Sant Anna Kellermann</creatorcontrib><creatorcontrib>Marques, Samara Silva</creatorcontrib><creatorcontrib>Franco, Rodrigo Fontanive</creatorcontrib><creatorcontrib>Silveiro, Sandra Pinho</creatorcontrib><creatorcontrib>Manfro, Roberto Ceratti</creatorcontrib><creatorcontrib>Camargo, Joíza Lins</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinica chimica acta</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pimentel, Ana Laura</au><au>Carvalho, Larissa Sant Anna Kellermann</au><au>Marques, Samara Silva</au><au>Franco, Rodrigo Fontanive</au><au>Silveiro, Sandra Pinho</au><au>Manfro, Roberto Ceratti</au><au>Camargo, Joíza Lins</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study</atitle><jtitle>Clinica chimica acta</jtitle><addtitle>Clin Chim Acta</addtitle><date>2015-05-20</date><risdate>2015</risdate><volume>445</volume><spage>48</spage><epage>53</epage><pages>48-53</pages><issn>0009-8981</issn><eissn>1873-3492</eissn><abstract>The role of glycated hemoglobin (A1C) in the screening and diagnosis of posttransplantation diabetes mellitus (PTDM) is still not entirely understood. We evaluated the use of A1C test in renal transplant recipients at four months after transplantation.
A total of 122 out of 274 patients without previous diabetes that underwent kidney transplantation were enrolled. ROC curve was used to analyze the performance of A1C to diagnose PTDM considering OGTT as the reference standard.
OGTT identified 32 (26.2%) patients with PTDM, whereas A1C≥6.5% (48mmol/mol) identified only 16 patients. A1C showed moderate accuracy to detect PTDM in the ROC curve [AUC 0.832 (95% CI 0.740–0.924, p<0.001)]. A1C of 5.8% (40mmol/mol) was the equilibrium point (sensitivity 75% and specificity 72.2%) and A1C≥6.2% (44mmol/mol) showed high specificity of 93.3%.
A1C≥6.5% (48mmol/mol) is not enough to be used alone in the diagnosis of PTDM. The combined use of A1C cut-off points of ≤5.8% (40mmol/mol) and ≥6.2% (44mmol/mol) would reduce the number of OGTT by 85%. The use of an algorithm with A1C test in combination with FPG and/or 2h-PG proved to be the most efficient strategy to diagnose or rule out PTDM.
•The performance of A1c to detect PTDM was evaluated in 122 patients that underwent kidney transplantation.•A1c ≥6.5% (48mmol/mol) is not enough to be used alone in the diagnosis of PTDM.•A1c ≤5.8% (40mmol/mol) presented adequate sensitivity to rule out PTDM.•A1c ≥6.2% (44mmol/mol) showed excellent specificity to rule in PTDM.•A1c test in combination with OGTT proved to be the most efficient alternative strategy to exclude or confirm PTDM.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>25797896</pmid><doi>10.1016/j.cca.2015.03.016</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3163-2097</orcidid></addata></record> |
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| subjects | A1C Adult Aged Biomarkers - blood Blood Glucose - metabolism Cross-Sectional Studies Diabetes Mellitus - blood Diabetes Mellitus - diagnosis Diabetes Mellitus - etiology Diabetes Mellitus - pathology Diagnostic accuracy Female Glucose Tolerance Test Glycated hemoglobin Glycated Hemoglobin A - metabolism Humans Kidney - metabolism Kidney - pathology Kidney Transplantation - adverse effects Male Middle Aged Posttransplantation diabetes mellitus PTDM Renal transplantation ROC Curve |
| title | Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study |
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