title: Comparison of diagnostic criteria to detect undiagnosed diabetes in hyperglycaemic patients with acute coronary syndrome.
abstract: BACKGROUND
  Elevated plasma glucose levels on admission (APG) are very common in patients with acute coronary syndrome (ACS) and can be the first indication of diabetes mellitus.
  
  
  OBJECTIVE
  To provide insight into the prevalence of previously undiagnosed diabetes and to compare different methods of diagnosing diabetes in patients with ACS.
  
  
  METHODS
  Patients with ACS with elevated APG who participated in the BIOMArCS 2 glucose trial underwent an oral glucose tolerance test (OGTT) prior to discharge. 130 patients were included who underwent metabolic assessment. Of these, 109 had an OGTT and 13 patients had pre-existing diabetes.
  
  
  RESULTS
  The OGTT results were categorised as (previously) undiagnosed diabetes in 35% of patients (fasting plasma glucose (FPG) ≥7.0 mmol/l or 2-h post-load glucose ≥11.1 mmol/l) and impaired glucose metabolism in 44% (FPG 6.1-6.9 mmol/l or post-load glucose 7.8-11.0 mmol/l), so only 21% had a normal glucose metabolism. Undiagnosed diabetes could not be adequately predicted with APG, FPG or HbA1c (area under the ROC curve 0.61, 0.75 and 0.72, respectively). Patients with abnormal glucose metabolism were significantly older, had higher admission HbA1c values, a higher Killip classification and more often had a prior stroke than patients with normal glucose metabolism.
  
  
  CONCLUSIONS
  79% of hyperglycaemic patients with ACS were found to have abnormal glucose metabolism. As APG, HbA1c and FPG had a low sensitivity to detect undiagnosed diabetes, an OGTT appears to be the best test to assess the presence of previously undiagnosed diabetes or impaired glucose metabolism in hyperglycaemic patients with ACS.
authors.affiliation: Department of Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: de Mulder
authors.forename: Rohit M
authors.initials: RM
authors.lastname: Oemrawsingh
authors.forename: Frank
authors.initials: F
authors.lastname: Stam
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Victor A
authors.initials: VA
authors.lastname: Umans
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D058065:Diabetic Cardiomyopathies / Q000175:diagnosis*; D042241:Early Diagnosis; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin