Fasting glucose, HbA1c, or oral glucose tolerance testing for the detection of glucose abnormalities in patients with acute coronary syndromes

• Published in: European journal of preventive cardiology 2013-08, Vol.20 (4), p.549-554
• Main Authors: Hage, Camilla, Lundman, Pia, Rydén, Lars, Mellbin, Linda
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - therapy; Aged; Biological and medical sciences; Biomarkers - blood; Blood Glucose - metabolism; Cardiology. Vascular system; Coronary heart disease; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Fasting - blood; Female; Glucose Intolerance - blood; Glucose Intolerance - complications; Glucose Intolerance - diagnosis; Glucose Tolerance Test; Glycated Hemoglobin A - metabolism; Heart; Humans; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Myocarditis. Cardiomyopathies; Patient Admission; Predictive Value of Tests; Prognosis
• ISSN: 2047-4873; 2047-4881; 2047-4881
• DOI: 10.1177/2047487312444371

Background:Due to the negative prognostic impact, it is important to accurately detect undiagnosed glucose perturbations in patients with acute coronary syndromes (ACS). Design: This study compares oral glucose tolerance test (OGTT) to fasting plasma glucose (FPG) and HbA1c as screening tools. Methods:Patients hospitalized for ACS had an OGTT, FPG, and HbA1c measured 4–21 (median 6) days after admission as a screening process for an intervention study. Results:Out of 174 patients, 75 (43%) had a normal glucose tolerance, 63 (36%) impaired glucose tolerance (IGT), and 36 (21%) diabetes type 2 (T2DM). Of these, 20 were non-eligible, and of the remaining 79 patients, 52 had IGT and 27 T2DM according to the OGTT. In patients with IGT, the median FPG was 6.0 mmol/l and the median HbA1c was 39 mmol/mol. The corresponding levels in patients with T2DM were 6.3 mmol/l and 41 mmol/mol, respectively. Seventeen of the 27 patients with T2DM according to OGTT had not been disclosed if the screening had been based on FPG. HbA1c identified two patients. Conclusions:Compared to OGTT, the use of FPG or HbA1c alone leaves a majority of patients with IGT or T2DM undetected when screening for unknown glucose perturbations as a part of total risk assessment of patients with ACS.