8 In a meta-analysis of six prospective studies, the incidence of type 2 diabetes mellitus in people with impaired glucose tolerance was 57.2 per 1000 person years.26 The incidence however, varied considerably, depending on the ethnicity of the individual, being increased in Mexican–Americans, Hispanics and Pima Indians. This has been supported by other publications.27 Even in the absence of frank diabetes mellitus, impaired glucose tolerance is associated with an increased risk of death. In a systematic review and

meta-analysis performed using MEDLINE until 1996, the results of 95 783 people were collated. A fasting plasma glucose level of 6.1 mmol/L and a 2 h OGTT glucose level of 7.8 mmol/L was associated with an increased relative risk of cardiovascular events of 1.33 (95% confidence interval (CI): 1.06–1.67) and 1.58 (95% CI: 1.19–2.10), respectively, selleck kinase inhibitor compared with a fasting plasma glucose level of 4.2 mmol/L.9 More recently, the Diabetes Epidemiology: Collabarotive Analysis of Diagnostic Criteria in Europe (DECODE) investigators examined 22 cohorts in Europe, totalling 29 714 people followed up for 11 years.10 This group demonstrated that elevated fasting plasma glucose levels and 2 h plasma glucose levels were

associated with a graded increased risk of mortality. There is no direct evidence documenting the outcome of people with impaired glucose tolerance who subsequently donate a kidney. Diabetes mellitus is a contraindication to living kidney donation due to the high risk of the development of nephropathy and cardiovascular disease. In line with this logic, impaired glucose tolerance is in addition a contraindication HIF-1�� pathway to living kidney donation. This is based on the high risk of the development of diabetes mellitus in people

with impaired glucose tolerance and the inherent risk of cardiovascular disease even without the development of diabetes mellitus. INTERNATIONAL GUIDELINES: The Amsterdam Forum on the Care of the Living Kidney Donor (2006) Megestrol Acetate . . .  individuals with a history of diabetes or fasting blood glucose ≥ 7 mmol/L on at least two occasions (or 2 h glucose with OGTT ≥ 11.1 mmol/L should not donate. The Canadian Council for Donation and Transplantation (2006) We recommend . . . to refer to existing guidelines regarding the assessment and eligibility of potential living kidney donors (e.g. Amsterdam Forum). European Renal Association-European Dialysis and Transplant Association (2000) . . .  exclusion criteria: . . . Diabetes mellitus  . . . UK Guidelines for Living Donor Kidney Transplantation (2005) Diabetes mellitus is an absolute contraindication to living donation. Prospective donors with an increased risk of type 2 diabetes mellitus because of family history, ethnicity or obesity should undergo a glucose tolerance test and only be considered further as donors if this is normal. 1 Conduct prospective, controlled studies on long-term living kidney donor outcomes.