Data from: Diabetes mellitus and prediabetes on kidney transplant waiting list- prevalence, metabolic phenotyping and risk stratification approach

Background: Despite a significant prognostic impact, little is known about disturbances in glucose metabolism among kidney transplant candidates. We assess the prevalence of diabetes mellitus (DM) and prediabetes on kidney transplant waiting list, its underlying pathophysiology and propose an approach for individual risk stratification. Methods: All patients on active kidney transplant waiting list of a large European university hospital transplant center were metabolically phenotyped. Results: Of 138 patients, 76 (55%) had disturbances in glucose metabolism. 22% of patients had known DM, 3% were newly diagnosed. 30% were detected to have prediabetes. Insulin sensitivity and -secretion indices allowed for identification of underlying pathophysiology and risk factors. Age independently affected insulin secretion, resulting in a relative risk for prediabetes of 2.95 (95%CI 1.38-4.83) with a cut-off at 48 years. Body mass index independently affected insulin sensitivity as a continuous variable. Conclusions: The prevalence of DM or prediabetes on kidney transplant waiting list is as high as 55%, with more than one third of patients previously undiagnosed. Oral glucose tolerance test is mandatory to detect all patients at risk. Metabolic phenotyping allows for differentiation of underlying pathophysiology and provides a basis for early individual risk stratification and specific intervention to improve patient and allograft outcome.

背景：尽管糖代谢紊乱对肾移植候选者具有重要的预后价值，但目前学界对该人群的糖代谢紊乱认知仍较为有限。本研究旨在明确肾移植等待队列中糖尿病（diabetes mellitus, DM）与糖尿病前期的患病率，探究其潜在病理生理机制，并提出个体化风险分层方案。
方法：本研究对欧洲某大型大学医院移植中心的活跃肾移植等待队列患者开展了代谢表型分型检测。
结果：共纳入138例患者，其中76例（55%）存在糖代谢紊乱。22%的患者已确诊糖尿病，3%为新诊断病例；另有30%被检出患有糖尿病前期。胰岛素敏感性与胰岛素分泌指数可用于明确潜在病理生理机制及危险因素。年龄对胰岛素分泌存在独立影响，以48岁为截断值时，糖尿病前期的相对风险为2.95（95%置信区间：1.38~4.83）。体重指数作为连续变量，对胰岛素敏感性存在独立影响。
结论：肾移植等待队列中糖尿病或糖尿病前期的患病率高达55%，其中超过三分之一的患者此前未被确诊。口服葡萄糖耐量试验是检出所有高危患者的必需手段。代谢表型分型可区分潜在病理生理机制，为早期个体化风险分层以及针对性干预以改善患者及移植肾预后提供依据。