Indirect Insulin Resistance Indices and Their Cut-Off Values for the Prediction of Post-Transplantation Diabetes Mellitus in Kidney Transplant Recipients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Study Population
2.2. Data Collection
2.3. Outcome Definition
2.4. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Cross-Sectional Associations
3.3. Prospective Analyses of Insulin Resistance Index and Incident PTDM in KTRs
3.4. ROC Curves and Cut-Off Values of Indirect Insulin Resistance Indices for Incident PTDM
3.5. Cut-Off Values of Indirect Insulin Resistance Indices Combined with TyG Index for Incident PTDM
3.6. Validation of Cox-Regression Model and Cut-Off Value of HOMA-IR
4. Discussion
5. Study Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Kuypers, D.R.J.; Claes, K.; Bammens, B.; Evenepoel, P.; Vanrenterghem, Y. Early Clinical Assessment of Glucose Metabolism in Renal Allograft Recipients: Diagnosis and Prediction of Post-Transplant Diabetes Mellitus (PTDM). Nephrol. Dial. Transplant. 2008, 23, 2033–2042. [Google Scholar] [CrossRef] [PubMed]
- Conte, C.; Secchi, A. Post-Transplantation Diabetes in Kidney Transplant Recipients: An Update on Management and Prevention. Acta Diabetol. 2018, 55, 763–779. [Google Scholar] [CrossRef] [PubMed]
- Montori, V.M.; Basu, A.; Erwin, P.J.; Velosa, J.A.; Gabriel, S.E.; Kudva, Y.C. Posttransplantation Diabetes A Systematic Review of the Literature. Diabetes Care 2002, 25, 583–592. [Google Scholar] [CrossRef] [PubMed]
- Langsford, D. Dysglycemia after Renal Transplantation: Definition, Pathogenesis, Outcomes and Implications for Management. World J. Diabetes 2015, 6, 1132. [Google Scholar] [CrossRef] [PubMed]
- Bloom, R.D.; Crutchlow, M.F. New-Onset Diabetes Mellitus in the Kidney Recipient: Diagnosis and Management Strategies. Clin. J. Am. Soc. Nephrol. 2008, 3, S38. [Google Scholar] [CrossRef] [PubMed]
- Hjelmesaeth, J.; Midtvedt, K.; Jenssen, T.; Hartmann, A. Insulin Resistance After Renal Transplantation Impact of Immunosuppressive and Antihypertensive Therapy. Diabetes Care 2001, 24, 2121–2126. [Google Scholar] [CrossRef] [PubMed]
- Mayer-Davis, E.J.; D’agostino, R., Jr.; Karter, A.J.; Haffner, S.M.; Rewers, M.J.; Saad, M.; Bergman, R.N. Intensity and Amount of Physical Activity in Relation to Insulin Sensitivity The Insulin Resistance Atherosclerosis Study. JAMA 1998, 279, 669–674. [Google Scholar] [CrossRef]
- Luan, F.L.; Steffick, D.E.; Ojo, A.O. New-Onset Diabetes Mellitus in Kidney Transplant Recipients Discharged on Steroid-Free Immunosuppression. Transplantation 2011, 91, 334–341. [Google Scholar] [CrossRef]
- Defronzo, R.A.; Tobin, J.D.; Andres, R. Glucose Clamp Technique: A Method for Quantifying Insulin Secretion and Resistance. Am. J. Physiol. 1979, 273, 214–223. [Google Scholar] [CrossRef]
- Greenfield, M.S.; Doberne, L.; Kraemer, F.; Tobey, T.; Reaven, G. Assessment of Insulin Resistance with the Insulin Suppression Test and the Euglycemic Clamp. Diabetes 1981, 30, 387–392. [Google Scholar] [CrossRef]
- Matthews, D.R.; Hosker, J.P.; Rudenski, A.S.; Naylor, B.A.; Treacher, D.F.; Turner, R.C. Homeostasis Model Assessment: Insulin Resistance and Beta-Cell Function from Fasting Plasma Glucose and Insulin Concentrations in Man. Diabetologia 1985, 28, 412–419. [Google Scholar] [CrossRef] [PubMed]
- Katz, A.; Nambi, S.S.; Mather, K.; Baron, A.D.; Follmann, D.A.; Sullivan, G.; Quon, M.J. Quantitative Insulin Sensitivity Check Index: A Simple, Accurate Method for Assessing Insulin Sensitivity In Humans. J. Clin. Endocrinol. Metab. 2000, 85, 2402–2410. [Google Scholar] [CrossRef] [PubMed]
- Guerrero-Romero, F.; Simental-Mendía, L.E.; González-Ortiz, M.; Martínez-Abundis, E.; Ramos-Zavala, M.G.; Hernández-González, S.O.; Jacques-Camarena, O.; Rodríguez-Morán, M. The Product of Triglycerides and Glucose, a Simple Measure of Insulin Sensitivity. Comparison with the Euglycemic-Hyperinsulinemic Clamp. J. Clin. Endocrinol. Metab. 2010, 95, 3347–3351. [Google Scholar] [CrossRef] [PubMed]
- Mazidi, M.; Kengne, A.P.; Katsiki, N.; Mikhailidis, D.P.; Banach, M. Lipid Accumulation Product and Triglycerides/Glucose Index Are Useful Predictors of Insulin Resistance. J. Diabetes Complicat. 2018, 32, 266–270. [Google Scholar] [CrossRef]
- Cai, R.; Wu, M.; Lin, M.; Guo, X.; Xing, Y. Pretransplant Homeostasis Model Assessment of Insulin Resistance and Fasting Plasma Glucose Predict New-Onset Diabetes After Renal Transplant in Chinese Patients. Transplant. Proc. 2019, 51, 768–773. [Google Scholar] [CrossRef] [PubMed]
- Choudhury, P.; Mukhopadhyay, P.; Roychowdhary, A.; Chowdhury, S.; Ghosh, S. Prevalence and Predictors of “New-Onset Diabetes after Transplantation” (NODAT) in Renal Transplant Recipients: An Observational Study. Ind. J. Endocrinol. Metab. 2019, 23, 273. [Google Scholar] [CrossRef]
- Dedinská, L.; Baltesová, T.; Beňa; Čellár, M.; Galajda, P.; Chrastina, M.; Jurčina, A.; Kováčiková, L.; Laca, L.; Lacková, E.; et al. Incidence of Diabetes Mellitus After Kidney Transplantation in Slovakia: Multicentric, Prospective Analysis. Transplant. Proc. 2016, 48, 3292–3298. [Google Scholar] [CrossRef]
- Tokodai, K.; Amada, N.; Haga, I.; Takayama, T.; Nakamura, A.; Kashiwadate, T. Insulin Resistance as a Risk Factor for New-Onset Diabetes after Kidney Transplantation. Transplant. Proc. 2014, 46, 537–539. [Google Scholar] [CrossRef]
- Xiaojie, N.; Bicheng, C.; Yongling, L.; Tingting, H.; Yi, Z.; Chen, Z. Metabolic-Related Index to Predict Post-Transplantation Diabetes Mellitus after Kidney Transplantation. Horm. Metab. Res. 2023, 55, 343–354. [Google Scholar] [CrossRef]
- De Vries, A.P.J.; Bakker, S.J.L.; Van Son, W.J.; Van Der Heide, J.J.H.; Ploeg, R.J.; The, H.T.; De Jong, P.E.; Gans, R.O.B. Metabolic Syndrome Is Associated with Impaired Long-Term Renal Allograft Function; Not All Component Criteria Contribute Equally. Am. J. Transplant. 2004, 4, 1675–1683. [Google Scholar] [CrossRef]
- Zelle, D.M.; Corpeleijn, E.; Deinum, J.; Stolk, R.P.; Gans, R.O.B.; Navis, G.; Bakker, S.J.L. Pancreatic β- Cell Dysfunction and Risk of New-Onset Diabetes after Kidney Transplantation. Diabetes Care 2013, 36, 1926–1932. [Google Scholar] [CrossRef]
- Levey, A.S.; Stevens, L.A.; Schmid, C.H.; Zhang, Y.L.; Iii, A.F.C.; Feldman, H.I.; Kusek, J.W.; Eggers, P.; Van Lente, F.; Greene, T. A New Equation to Estimate Glomerular Filtration Rate Andrew. Ann. Intern. Med. 2009, 150, 604–612. [Google Scholar] [CrossRef]
- Bala, C.; Gheorghe-Fronea, O.; Pop, D.; Pop, C.; Caloian, B.; Comsa, H.; Bozan, C.; Matei, C.; Dorobantu, M. The Association Between Six Surrogate Insulin Resistance Indexes and Hypertension: A Population-Based Study. Metab. Syndr. Relat. Disord. 2019, 17, 328–333. [Google Scholar] [CrossRef]
- Fan, J.; Gao, S.T.; Wang, L.J.; Qian, Z.L.; Zhou, Z.Q.; Liu, X.Z. Association of Three Simple Insulin Resistance Indexes with Prehypertension in Normoglycemic Subjects. Metab. Syndr. Relat. Disord. 2019, 17, 374–379. [Google Scholar] [CrossRef] [PubMed]
- Sharif, A.; Hecking, M.; de Vries, A.P.J.; Porrini, E.; Hornum, M.; Rasoul-Rockenschaub, S. Proceedings from an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions. Am. J. Transpl. 2014, 14, 1992–2000. [Google Scholar] [CrossRef] [PubMed]
- Eisenga, M.F.; Zelle, D.M.; Sloan, J.H.; Gaillard, C.A.J.M.; Bakker, S.J.L.; Dullaart, R.P.F. High Serum PCSK9 Is Associated with Increased Risk of New-Onset Diabetes after Transplantation in Renal Transplant Recipients. Diabetes Care 2017, 40, 894–901. [Google Scholar] [CrossRef] [PubMed]
- Akobeng, A.K. Understanding Diagnostic Tests 3: Receiver Operating Characteristic Curves. Acta Paediatr. Int. J. Paediatr. 2007, 96, 644–647. [Google Scholar] [CrossRef]
- Kahn, S.E.; Cooper, M.E.; Del Prato, S. Pathophysiology and Treatment of Diabetes. Nutr. Diabetes 2014, 383, 1068–1083. [Google Scholar] [CrossRef]
- Laakso, M. How Good a Marker Is Insulin Level for Insulin Resistance? Am. J. Epidemiol. 1993, 137, 959–965. [Google Scholar] [CrossRef]
- Oterdoom, L.H.; De Vries, A.P.J.; Van Son, W.J.; Homan Van Der Heide, J.J.; Ploeg, R.J.; Gansevoort, R.T.; De Jong, P.E.; Gans, R.O.B.; Bakker, S.J.L. Validation of Insulin Resistance Indexes in a Stable Renal Transplant Population. Diabetes Care 2005, 28, 2424–2429. [Google Scholar] [CrossRef]
- Szili-Torok, T.; Sokooti, S.; Osté, M.C.J.; Gomes-Neto, A.W.; Dullaart, R.P.F.; Bakker, S.J.L.; Tietge, U.J.F. Remnant Lipoprotein Cholesterol Is Associated with Incident New Onset Diabetes after Transplantation (NODAT) in Renal Transplant Recipients: Results of the Transplant Lines Biobank and Cohort Studies. Cardiovasc. Diabetol. 2022, 21, 41. [Google Scholar] [CrossRef] [PubMed]
- Sokooti, S.; Szili-Torok, T.; Flores-Guerrero, J.L.; Osté, M.C.J.; Gomes-Neto, A.W.; Kootstra-Ros, J.E.; Heerspink, H.J.L.; Connelly, M.A.; Bakker, S.J.L.; Dullaart, R.P.F. High-Density Lipoprotein Particles and Their Relationship to Posttransplantation Diabetes Mellitus in Renal Transplant Recipients. Biomolecules 2020, 10, 481. [Google Scholar] [CrossRef]
- Oterdoom, L.H.; De Vries, A.P.J.; Gansevoort, R.T.; Van Son, W.J.; Van Der Heide, J.J.H.; Ploeg, R.J.; De Jong, P.E.; Gans, R.O.B.; Bakker, S.J.L. Determinants of Insulin Resistance in Renal Transplant Recipients. Transplantation 2007, 83, 29–35. [Google Scholar] [CrossRef]
- Martin, B.C.; Warram, J.H.; Krolewski, A.S.; Soeldner, J.S.; Kahn, C.R.; Martin, B.C.; Bergman, R.N. Role of Glucose and Insulin Resistance in Development of Type 2 Diabetes Mellitus: Results of a 25-Year Follow-up Study. Lancet 1992, 340, 925–929. [Google Scholar] [CrossRef] [PubMed]
- Moon, S.; Park, J.H.; Jang, E.J.; Park, Y.K.; Yu, J.M.; Park, J.S.; Ahn, Y.; Choi, S.H.; Yoo, H.J. The Cut-off Values of Surrogate Measures for Insulin Sensitivity in a Healthy Population in Korea According to the Korean National Health and Nutrition Examination Survey (KNHANES) 2007–2010. J. Korean Med. Sci. 2018, 33, e197. [Google Scholar] [CrossRef] [PubMed]
- Placzkowska, S.; Pawlik-Sobecka, L.; Kokot, I.; Piwowar, A. Indirect Insulin Resistance Detection: Current Clinical Trends and Laboratory Limitations. Biomed. Pap. 2019, 163, 187–199. [Google Scholar] [CrossRef]
- Muniyappa, R.; Lee, S.; Chen, H.; Quon, M.J. Current Approaches for Assessing Insulin Sensitivity and Resistance in Vivo: Advantages, Limitations, and Appropriate Usage. Am. J. Physiol. Endocrinol. Metab. 2008, 294, 15–26. [Google Scholar] [CrossRef]
- Harano, Y.; Hidaka, H.; Ohgaku, S.; Haneda, M.; Motoi, S.; Kawagoe, K.; Shigeta, Y.; Abe, H. Glucose, Insulin, and Somatostatin Infusion for the Determination of Insulin Sensitivity In Vivo. Metabolism 1978, 27, 1449–1452. [Google Scholar] [CrossRef]
- Kim, B.; Choi, H.Y.; Kim, W.; Ahn, C.; Lee, J.; Kim, J.G.; Kim, J.; Shin, H.; Yu, J.M.; Moon, S. The Cut-off Values of Surrogate Measures for Insulin Resistance in the Korean Population According to the Korean Genome and Epidemiology Study (KOGES). PLoS ONE 2018, 13, e0206994. [Google Scholar] [CrossRef]
- Guerrero-Romero, F.; Villalobos-Molina, R.; Jiménez-Flores, J.R.; Simental-Mendia, L.E.; Méndez-Cruz, R.; Murguía-Romero, M.; Rodríguez-Morán, M. Fasting Triglycerides and Glucose Index as a Diagnostic Test for Insulin Resistance in Young Adults. Arch. Med. Res. 2016, 47, 382–387. [Google Scholar] [CrossRef]
- Rao, N.; Rathi, M.; Sharma, A.; Ramachandran, R.; Kumar, V.; Kohli, H.S.; Gupta, K.L.; Sakhuja, V. Pretransplant HbA1c and Glucose Metabolism Parameters in Predicting Posttransplant Diabetes Mellitus and Their Course in the First 6 Months after Living-Donor Renal Transplant. Exp. Clin. Transplant. 2018, 16, 446–454. [Google Scholar] [CrossRef]
- Demirci, M.S.; Toz, H.; Yilmaz, F.; Ertilav, M.; Asci, G.; Ozkahya, M.; Zeytinoglu, A.; Nart, D.; Ok, E. Risk Factors and Consequences of Post-Transplant Diabetes Mellitus. Clin. Transplant. 2010, 24, E170–E177. [Google Scholar] [CrossRef] [PubMed]
- Chakkera, H.A.; Weil, E.J.; Swanson, C.M.; Dueck, A.C.; Heilman, R.L.; Reddy, K.S.; Hamawi, K.; Khamash, H.; Moss, A.A.; Mulligan, D.C.; et al. Pretransplant Risk Score for New-Onset Diabetes after Kidney Transplantation. Diabetes Care 2011, 34, 2141–2145. [Google Scholar] [CrossRef] [PubMed]
- Raimi, T.H.; Dele-Ojo, B.F.; Dada, S.A.; Fadare, J.O.; Ajayi, D.D.; Ajayi, E.A.; Ajayi, O.A. Triglyceride-Glucose Index and Related Parameters Predicted Metabolic Syndrome in Nigerians. Metab. Syndr. Relat. Disord. 2021, 19, 76–82. [Google Scholar] [CrossRef]
- Mirr, M.; Skrypnik, D.; Bogdański, P.; Owecki, M. Newly Proposed Insulin Resistance Indexes Called TyG-NC.Pdf. J. Endocrinol. Investig. 2021, 44, 2831–2843. [Google Scholar] [CrossRef] [PubMed]
- Hedblad, B.; Nilsson, P.; Janzon, L.; Berglund, G. Relation between Insulin Resistance and Carotid Intima-Media Thickness and Stenosis in Non-Diabetic Subjects. Diabet. Med. 2000, 17, 299–307. [Google Scholar] [CrossRef] [PubMed]
- Esteghamati, A.; Ashraf, H.; Esteghamati, A.R.; Meysamie, A.; Khalilzadeh, O.; Nakhjavani, M.; Abbasi, M. Optimal Threshold of Homeostasis Model Assessment for Insulin Resistance in an Iranian Population: The Implication of Metabolic Syndrome to Detect Insulin Resistance. Diabetes Res. Clin. Pract. 2009, 84, 279–287. [Google Scholar] [CrossRef]
- Marques-Vidal, P.; Mazoyer, E.; Bongard, V.; Gourdy, P.; Ruidavets, J.-B.; Drouet, L.; Ferrières, J. Prevalence of Insulin Resistance Syndrome in Southwestern France and Its Relationship with Inflammatory and Hemostatic Markers. Diabetes Care 2002, 25, 1371–1377. [Google Scholar] [CrossRef]
- Ghasemi, A.; Tohidi, M.; Derakhshan, A.; Hasheminia, M.; Azizi, F.; Hadaegh, F. Cut-off Points of Homeostasis Model Assessment of Insulin Resistance, Beta-Cell Function, and Fasting Serum Insulin to Identify Future Type 2 Diabetes: Tehran Lipid and Glucose Study. Acta Diabetol. 2015, 52, 905–915. [Google Scholar] [CrossRef]
- Lee, C.H.; Shih, A.Z.L.; Woo, Y.C.; Fong, C.H.Y.; Leung, O.Y.; Janus, E.; Cheung, B.M.Y.; Lam, K.S.L. Optimal Cut-Offs of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to Identify Dysglycemia and Type 2 Diabetes Mellitus: A15-Year Prospective Study in Chinese. PLoS ONE 2016, 11, e0163424. [Google Scholar] [CrossRef]
- Ekstrand, A.V.; Eriksson, J.G.; Grönhagen-Riska, C.; Ahonen, P.J.; Groop, L.C. Insulin Resistance and Insulin Deficiency in the Pathogenesis of Posttransplantation Diabetes in Man. Transplantation 1992, 53, 563–659. [Google Scholar] [CrossRef] [PubMed]
Variables | |
Participants, n | 472 |
General characteristics | |
Men, % | 56.4 |
Age, year | 50.4 ± 12.1 |
Current smoker, % | 40.9 |
Alcohol use, never, % | 45.1 |
Weight, kg | 76.3 ± 13.5 |
Height, cm | 172.5 ± 9.7 |
BMI, kg/m2 | 25.6 ± 4.1 |
Transplant demographics | |
Time since renal transplantation, year | 6.1 (2.6–11.7) |
Donor age, year | 39.5 (23.0–51.0) |
Living donor, % | 15.0 |
Dialysis duration, months | 27 (13–49) |
Rejection, % | 45.5 |
Blood pressure | |
Systolic blood pressure, mmHg | 151.4 ± 22.4 |
Diastolic blood pressure, mmHg | 898.8 ± 9.9 |
Metabolic variables | |
Total cholesterol, mmol/L | 5.6 (5.0–6.2) |
LDL cholesterol, mmol/L | 3.6 (3.0–4.1) |
HDL cholesterol, mmol/L | 1.1 (0.9–1.3) |
Triglycerides, mmol/L | 1.9 (1.4–2.6) |
Glucose Homeostasis | |
Glucose, mmol/L | 4.5 ± 0.5 |
HbA1c, % | 6.3 ± 0.8 |
Insulin, μU/mL | 10.3 (7.7–14.1) |
hs-CRP, mg/L | 1.9 (0.7–4.6) |
Renal function | |
Serum Creatinin mmol/L | 137.0 (113.0–171.0) |
eGFR, mL/min per 1.73 m2 | 46.7 (35.7–57.6) |
UAE, g/24 h | 0.2 (0.0–0.50) |
CMV infection, % | 29.2 |
Medication use | |
Statin use, % | 47.9 |
Anti-hypertensive medication, % | 85.4 |
Prednisolone, mg/day | 9.2 ± 1.3 |
Calcineurin inhibitor, % | 77.3 |
Cyclosporine, % | 63.8 |
Tacrolimus, % | 13.6 |
Proliferation inhibitor, % | 55.8 |
Azathioprine,% | 33.9 |
Mycophenolic acid, % | 41.9 |
HOMA-IR, n = 68 | HR (95% CI) Per 1 SD | p Value |
---|---|---|
Crude | 2.61 (1.99–3.42) | <0.001 |
Model 1+ | 2.79 (2.07–3.76) | <0.001 |
+BMI | 2.26 (1.62–3.14) | <0.001 |
+HbA1C | 2.37 (1.75–3.22) | <0.001 |
+TG, HDL-C | 2.35 (1.71–3.22) | <0.001 |
+VAI | 2.30 (1.68–3.16) | <0.001 |
VAI, n = 68 | HR (95% CI) Per 1 SD | p Value |
Crude | 1.97 (1.53–2.53) | <0.001 |
Model 1+ | 2.09 (1.62–2.70) | <0.001 |
+Glucose | 1.92 (1.49–2.47) | <0.001 |
+HbA1c | 2.12 (1.61–2.79) | <0.001 |
+HOMA-IR | 1.57 (1.20–2.04) | 0.001 |
LAP, n = 68 | HR (95% CI) Per 1 SD | p Value |
Crude | 2.39 (1.84–3.10) | <0.001 |
Model 1+ | 2.62 (1.98–3.46) | <0.001 |
+glucose | 2.40 (1.82–3.16) | <0.001 |
+HbA1c | 2.67 (1.99–3.57) | <0.001 |
+HDL-C | 2.62 (1.95–3.51) | <0.001 |
+HOMA-IR | 1.94 (1.44–2.63) | <0.001 |
TyG index, n = 68 | HR (95% CI) Per 1 SD | p Value |
Crude | 2.38 (1.83–3.10) | <0.001 |
Model 1 | 2.58 (1.96–3.39) | <0.001 |
+BMI | 2.10 (1.57–2.83) | <0.001 |
+HbA1C | 2.48 (1.85–3.31) | <0.001 |
+HDL-C | 2.52 (1.89–3.36) | <0.001 |
Insulin Resistance Index | Cut-Off Value | Sensitivity | Specificity | HR (95% CI) |
---|---|---|---|---|
HOMA-IR | 2.47 | 75.0 | 71.3 | 6.42 (3.67–11.25) |
VAI | 4.01 | 61.8 | 72.8 | 4.10 (2.48–6.77) |
LAP | 87.04 | 64.7 | 75.2 | 5.82 (3.46–9.80) |
TyG index | 4.94 | 51.5 | 83.9 | 5.73 (3.45–9.52) |
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Sokooti, S.; Szili-Török, T.; Heerspink, H.J.L.; Dullaart, R.P.F.; Bakker, S.J.L. Indirect Insulin Resistance Indices and Their Cut-Off Values for the Prediction of Post-Transplantation Diabetes Mellitus in Kidney Transplant Recipients. J. Clin. Med. 2023, 12, 7296. https://doi.org/10.3390/jcm12237296
Sokooti S, Szili-Török T, Heerspink HJL, Dullaart RPF, Bakker SJL. Indirect Insulin Resistance Indices and Their Cut-Off Values for the Prediction of Post-Transplantation Diabetes Mellitus in Kidney Transplant Recipients. Journal of Clinical Medicine. 2023; 12(23):7296. https://doi.org/10.3390/jcm12237296
Chicago/Turabian StyleSokooti, Sara, Tamás Szili-Török, Hiddo J. L. Heerspink, Robin P. F. Dullaart, and Stephan J. L. Bakker. 2023. "Indirect Insulin Resistance Indices and Their Cut-Off Values for the Prediction of Post-Transplantation Diabetes Mellitus in Kidney Transplant Recipients" Journal of Clinical Medicine 12, no. 23: 7296. https://doi.org/10.3390/jcm12237296
APA StyleSokooti, S., Szili-Török, T., Heerspink, H. J. L., Dullaart, R. P. F., & Bakker, S. J. L. (2023). Indirect Insulin Resistance Indices and Their Cut-Off Values for the Prediction of Post-Transplantation Diabetes Mellitus in Kidney Transplant Recipients. Journal of Clinical Medicine, 12(23), 7296. https://doi.org/10.3390/jcm12237296