title: 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.
abstract: OBJECTIVE
  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.
  
  
  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%).
  
  
  CONCLUSIONS
  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.
authors: Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm 171 76, Sweden Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden vivecagyberg@gmail.com.
authors: Viveca
authors: V
authors: Gyberg
authors: Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Department of Public Health, Ghent University, Ghent, Belgium.
authors: Dirk
authors: D
authors: De Bacquer
authors: Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors: Kornelia
authors: K
authors: Kotseva
authors: Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Department of Public Health, Ghent University, Ghent, Belgium.
authors: Guy
authors: G
authors: De Backer
authors: Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany.
authors: Oliver
authors: O
authors: Schnell
authors: Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Disease Risk Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors: Jouko
authors: J
authors: Sundvall
authors: Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Centre for Vascular Prevention, Danube-University Krems, Krems, Austria Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
authors: Jaakko
authors: J
authors: Tuomilehto
authors: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors: David
authors: D
authors: Wood
authors: Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm 171 76, Sweden.
authors: Lars
authors: L
authors: Rydén
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003324:Coronary Artery Disease / Q000150:complications*; D003430:Cross-Sectional Studies; D003925:Diabetic Angiopathies / Q000150:complications*; D042241:Early Diagnosis; D005215:Fasting / Q000097:blood; D005260:Female; D044882:Glucose Metabolism Disorders / Q000175:diagnosis*; D005951:Glucose Tolerance Test / Q000379:methods; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Coronary artery disease; Diabetes; HbA1c; Impaired fasting glucose; Impaired glucose tolerance; Oral glucose tolerance test