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

Abstract
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.
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%).
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

Dirk De Bacquer
Author

Kornelia Kotseva
Author

Guy De Backer
Author

Oliver Schnell
Author

Jouko Sundvall
Author

Jaakko Tuomilehto
Author

David Wood
Author

Lars Rydén
Author

K. Kotseva
Author

G. De Backer
Author

P. Amouyel
Author

J. Bruthans
Author

A. Castro Conde
Author

R. Cifkova
Author

D. De Bacquer
Author

J. De Sutter
Author

J.W. Deckers
Author

M. Dilic
Author

M. Dolzhenko
Author

A. Erglis
Author

T. Ferreira
Author

Z. Fraz
Author

D. Gaita
Author

S. Gielen
Author

N. Gotcheva
Author

I. Goudevenos
Author

V. Gyberg
Author

P. Heuschmann
Author

A. Laucevicius
Author

S. Lehto
Author

D. Lovic
Author

M. Manini
Author

A.P. Maggioni
Author

D. Miličić
Author

D. Moore
Author

E. Nicolaides
Author

A. Pajak
Author

N. Pogosova
Author

Ž. Reiner
Author

L. Rydén
Author

O. Schnell
Author

M. Stagmo
Author

S. Störk
Author

J. Sundvall
Author

L. Tokgözoğlu
Author

J. Tuomilehto
Author

D. Vulic
Author

D. Wood
Author

D.A. Wood
Author

K. Kotseva
Author

C. Jennings
Author

A. Adamska
Author

L. Rydén
Author

V. Gyberg
Author

J. Tuomilehto
Author

O. Schnell
Author

M. Manini
Author

T. Ferreira
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C. Taylor
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M. Konte
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M. Glemot
Author

D. De Bacquer
Author

G. De Backer
Author

J. Sundvall
Author

L. Lund
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J. Leiviskä
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D. De Bacquer
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G. De Backer
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M. De Pauw
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C. Ghysbrecht
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