Masked alterations of glucose metabolism among patients awaiting kidney transplantation: Metabolic phenotyping and screening strategies

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Background Patients awaiting kidney transplantation are recommended to undergo systematic oral glucose tolerance tests (OGTT) to detect glucose metabolic alterations (GMA) that heighten the risk of posttransplant diabetes. Aims (a) To determine GMA prevalence and metabolic phenotypes; (b) assess optimal screening strategies for abnormal OGTT detection; and (c) evaluate one-year GMA trajectory through repeated OGTT during the waiting list period. Methods OGTTs were conducted on 182 wait-listed patients without diabetes, with 46 undergoing a repeat test after one year. Results Impaired glucose tolerance (IGT) was most common (23.1%). Undiagnosed diabetes (uDM) and isolated impaired fasting glucose (IFG) were observed in 6% and 4.4%, respectively. Patients with IGT/uDM exhibited decreased insulin secretion, while isolated IFG patients showed reduced insulin sensitivity. Abnormal OGTT correlated with statin therapy [OR 2.4 (1.17–4.9); P = 0.02], fasting glucose [OR 1.03 (1.01–1.06); P = .02], and age [OR 1.03 (1–1.06); P = 0.048]. Patients below age (51 years) and fasting glucose (100 mg/dL) thresholds, not on statins, had lower odds of abnormal OGTT potentially reducing routine testing needs by 26%. Transition from normal to abnormal OGTT after one year correlated with higher baseline BMI [27.5 kg/m 2 (IQR 25.6–31.7) vs. 24.1 kg/m 2 (IQR 21.3–25.8); P = 0.04], lower insulin sensitivity [Matsuda index 15.7 (IQR 11.4–24.5) vs. 22.9 (IQR 15.5–37); P = 0.049], and statin use (75% vs. 32%; P = 0.047). Conclusions One-third of wait-listed patients without manifest diabetes exhibit abnormal OGTT. Age, fasting glucose, and statin use increase risk. Patients below age and fasting glucose thresholds, without statins, have low abnormal OGTT likelihood, potentially reducing routine testing. Annual OGTT may benefit patients initially with normal results, if overweight/obese, or on statins.

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