Study protocols Demographic
Study results   Conclusions References

N= 188  >6 mo. postTx,

OGTT performed in patients with FPG < 7.0 mmol/L (n= 188) 
White > 90% ROC analyses
  • Optimal FPG predictive of NODAT: 101 mg/dL; 5.6 mmol/L (AUC= 0.70; sensitivity 64; specificity 67, positive predictive 20; negative predictive 93
  • Optimal FPG predictive of IGT less well-defined (AUC= 0.54)
  • Prevalence of NODAT (OGTT vs. FPG alone 17% vs. 6%, respectively;  P<0.0001)
FPG may not be the optimal screening or diagnostic tool due to lack of sensitivity & specificity

OGTT should be considered as a routine screening test in all renal transplant recipients
Armstrong et al.

N=122  > 6 months postTx

OGTT performed in patients with 2 FPG values between 5.6-6.9 mmol/L
White 96%
Asian 3%
Afro-Caribbean 1%
  OGTT revealed 10  had overt DM, 9% IGT alone, 18% IFG alone, 14% combined IFG and IGT   FPG underestimates IGT and NODAT prevalence

Routine use of OGTT is a valuable clinical tool to risk stratify patient for NODAT
Sharif et al.


All pts completed OGTT 5 days potTx

Mean f/u: 42.8 + 16.9 months
White 91.4%
Blacks 1.4%
Arabic 7.2%
Hispanics 0%
  • 17.8% developed NODAT
  • A normal (vs. diabetic) OGTT at day 5 postTx associated with↓NODAT risk (OR= 0.003; P=0.0002)
Sensitivity 93.4; Specificity 71.9%
  • A normal (vs diabetic) FPG on day 5 associated  with ↓NODAT risk (OR= 0.06; P< 0.0001)
Sensitivity 21.6% Specificity 97.6%  
  A  normal FPG (vs. diabetic) and a normal OGTT (vs diabetic) at 5 days postTx seems to identify patients at ↓NODAT risk Kuypers et al.
FPG and A1C

N=199  > 3 months postTx

All patients had a history of normal FPG prior to study

Normal A1C defined as < 6.1 % 
African Americans 81.9%
  • Twenty (10.1%) had A1C > 6.1% (6 of whom had both ↑A1C and new onset ↑FPG @ study entry, and 14 had ↑A1C only
  • Of the 6 pts with both ↑A1C and new onset ↑FPG, 5 were diagnosed with NODAT
  • Of the 14 pts with ↑A1C only, 3 were diagnosed with NODAT and 4 with glucose intolerance
  • The odds of African Americans having ↑A1C were 2.8 times higher than other races
  • High normal FPG was significantly associated with an ↑A1C (P= 0.003)
  • Race effect marginally significant when adjusted for FPG (P=0.08)

A1C level  was a more sensitive test than FPG in detecting NODAT

A1C testing should be considered as a screening test for NODAT, especially in African Americans

Hoban et al.
FPG, A1C , and OGTT

N=929 @ 10-week postTx

Patients who had
both FPG < 7.0mmol/L and A1C levels available were evaluated
White 95% ROC analysis:
FPG: AUC  0.761 (95CI 0.714-0.809)
A1C: AUC  0.817 (95CI 0.758-0.876)

Performing OGTT on patients with FPG > 5.3 mmol/L or A1C > 5.8% predicted NODAT with 81% and 83% sensitivity, requiring 49 and 41 of the patients to be tested, respectively

Combined criterion of FPG > 5.0 mmol/L and A1C > 5.7 provided a sensitivity of 79% from testing 29% of the population
  OGTT should be considered in patients with FPG between 5.3-6.9 mmol/L or A1C > 5.8%
In those with combined FPG > 5 mmol/L and A1C > 5.7%
Valderhaugh et al.
Abbreviations: PostTx: post transplant; ROC: receiver operating characteristics; AUC: area under the curve
Table 1: Clinical studies evaluating the predictive diagnostic tools for the development of NODAT.