Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c: a report from EUROASPIRE IV—a survey from the European Society of Cardiology

European Heart Journal

10 February 2015
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ESC Journals

Abstract

AbstractAims

Three methods are used to identify dysglycaemia: fasting plasma glucose (FPG), 2-h post-load plasma glucose (2hPG) from the oral glucose tolerance test (OGTT), and glycated haemoglobin A1c (HbA1c). The aim was to describe the yield and concordance of FPG, HbA1c, and 2hPG alone, or in combination, to identify dysglycaemia in patients with coronary artery disease.

Methods and results

In EUROASPIRE IV, a cross-sectional survey of patients aged 18–80 years with coronary artery disease in 24 European countries, 4004 patients with no reported history of diabetes had FPG, 2hPG, and HbA1c measured. All participants were divided into different glycaemic categories according to the ADA and WHO criteria for dysglycaemia. Using all screening tests together, 1158 (29%) had undetected diabetes. Out of them, the proportion identified by FPG was 75%, by 2hPG 40%, by HbA1c 17%, by FPG + HbA1c 81%, and by OGTT (=FPG + 2hPG) 96%. Only 7% were detected by all three methods FPG, 2hPG, and HbA1c. The ADA criteria (FPG + HbA1c) identified 90% of the population as having dysglycaemia compared with 73% with the WHO criteria (OGTT = FPG + 2hPG). Screening according to the ADA criteria for FPG + HbA1c identified 2643 (66%) as having a ‘high risk for diabetes’, while the WHO criteria for FPG + 2hPG identified 1829 patients (46%).

Conclusion

In patients with established coronary artery disease, the OGTT identifies the largest number of patients with previously undiagnosed diabetes and should be the preferred test when assessing the glycaemic state of such patients.

Contributors

Viveca Gyberg
Viveca Gyberg

Author

Karolinska Institute Stockholm , Sweden

M. Dilic
M. Dilic

Author

Z. Fraz
Z. Fraz

Author

D. Gaita
D. Gaita

Author

S. Lehto
S. Lehto

Author

D. Lovic
D. Lovic

Author

D. Moore
D. Moore

Author

A. Pajak
A. Pajak

Author

D. Vulic
D. Vulic

Author

D. Wood
D. Wood

Author

M. Konte
M. Konte

Author

L. Lund
L. Lund

Author

D. Vulic
D. Vulic

Author

S. Srdic
S. Srdic

Author

M. Dilic
M. Dilic

Author

A. Begic
A. Begic

Author

M. Kulic
M. Kulic

Author

O. Mayer
O. Mayer

Author

J. Vanek
J. Vanek

Author

S. Lehto
S. Lehto

Author

S. Balik
S. Balik

Author

S. Held
S. Held

Author

K. Nolte
K. Nolte

Author

V. Wahl
V. Wahl

Author

G. Ertl
G. Ertl

Author

R. Leyh
R. Leyh

Author

L. Lilis
L. Lilis

Author

D. Moore
D. Moore

Author

E. Keive
E. Keive

Author

J. Vilks
J. Vilks

Author

D. Gaita
D. Gaita

Author

C. Avram
C. Avram

Author

L. Gaita
L. Gaita

Author

A. Lazar
A. Lazar

Author

M. Mal
M. Mal

Author

C. Sasec
C. Sasec

Author

S. Calin
S. Calin

Author

D. Lovic
D. Lovic

Author

B. Lovic
B. Lovic

Author

I. Tasic
I. Tasic

Author

Z. Fras
Z. Fras

Author

B. Jug
B. Jug

Author

C. Hage
C. Hage

Author

S. Asil
S. Asil

Author

B. Kaya
B. Kaya

Author

S. Altay
S. Altay

Author

N. Çam
N. Çam

Author

M. Eren
M. Eren

Author

G. Ateş
G. Ateş

Author

S. Emet
S. Emet

Author

B. Umman
B. Umman

Author

N. Poçi
N. Poçi

Author

L. Lurie
L. Lurie

Author

M. Lutay
M. Lutay

Author

D. Wood
D. Wood

Author

J. Evans
J. Evans

Author

M. Dancy
M. Dancy

Author