title: Prevalence and characteristics of impaired glucose metabolism in patients referred to comprehensive cardiac rehabilitation: the DANSUK study.
abstract: BACKGROUND
  Lifestyle and pharmacological interventions can delay the progression of impaired glucose tolerance (IGT) to type 2 diabetes (T2DM), and there is growing evidence that earlier detection of T2DM and intensified risk factor management may result in improved cardiovascular morbidity and mortality. We studied the prevalence of impaired glucose metabolism (T2DM, IGT and impaired fasting glucose; IFG) in patients referred to cardiac rehabilitation, and further studied whether we could identify groups in which an oral glucose tolerance test (OGTT) need not be performed.
  
  
  METHODS
  As part of a cardiac rehabilitation trial, 201 patients participated. Patients without a diagnosis of T2DM (N=159) underwent an OGTT 3 months after inclusion.
  
  
  RESULTS
  Forty-two patients (21%) had known T2DM at enrolment. Based on the OGTT, 26 patients (13%) had unrecognized T2DM, 36 (18%) had IGT and 19 (9%) were diagnosed with isolated IFG according to the World Health Organization definition. Using fasting plasma glucose alone, 19% of the patients with unrecognized T2DM and two-thirds of patients with IGT would be misclassified. Using IFG as a means to detect IGT showed a sensitivity of only 33% and a positive predictive value of 39%.
  
  
  CONCLUSIONS
  More than 60% of the patients (123/201) referred to cardiac rehabilitation had impaired glucose metabolism and 18% of the screened patients (29/159) would be misclassified if an OGTT was omitted. IFG and IGT did not identify the same patients or the same cardiovascular risk profile. An OGTT test should therefore be considered a constituent part of routine care management in cardiac rehabilitation settings.
authors.affiliation: Bispebjerg University Hospital, Department of Cardiology, Copenhagen bNational Institute of Public Health, Copenhagen, Denmark. soja@dadlnet.dk
authors.forename: Anne Merete
authors.initials: AM
authors.lastname: Boas Soja
authors.forename: Ann-Dorthe Olsen
authors.initials: AD
authors.lastname: Zwisler
authors.forename: Thomas
authors.initials: T
authors.lastname: Melchior
authors.forename: Eva
authors.initials: E
authors.lastname: Hommel
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Mette
authors.initials: M
authors.lastname: Madsen
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology*; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D001786:Blood Glucose