Editor's Choice- Diagnosis of type 2 diabetes and prediabetes among patients with acute coronary syndromes.
BACKGROUND
Previously undetected dysglycaemia is common among patients with acute coronary syndromes (ACSs). The aim of this study was to identify the most reliable method of diagnosing type 2 diabetes mellitus (T2DM) and prediabetes in ACS patients.


METHODS
Patients admitted to the coronary care unit with ACSs and no previous history of T2DM were consecutively included in the study. Glucose metabolism was measured by glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) with a standard oral glucose tolerance test during hospital admission, and this process was repeated 3 months later. In this study, the diagnosis of T2DM required at least two measurements above the diabetes cut-off point according to current American Diabetes Association and World Health Organization criteria.


RESULTS
A total of 250 patients were included in the study. T2DM was diagnosed in 7.2%. The sensitivities for detecting T2DM were 33.3%, 61.1% and 77.8% during admission and 27.8%, 61.1% and 72.2% at follow-up for HbA1c, FPG and 2hPG, respectively. The positive predictive values (PPVs) for diagnosing T2DM were 100%, 91.7% and 51.9% during admission and 71.4%, 91.7% and 65.0% at follow-up for HbA1c, FPG and 2hPG, respectively. The specificities and negative predictive values were high for all methods. By combining all measurements, the sensitivity was 100% and the PPV was 44.2%, while the combination of all HbA1c and FPG measurements provided 88.9% sensitivity and 80.0% PPV.


CONCLUSIONS
Diagnosis of T2DM can be reliably carried out by repeated measurements of FPG and HbA1c in ACS patients, with limited added value of an oral glucose tolerance test.
1 Department of Medicine, Division of Cardiology, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland.|2 University of Iceland, School of Health Sciences, Reykjavik, Iceland.
Thorarinn A
TA
Bjarnason
2 University of Iceland, School of Health Sciences, Reykjavik, Iceland.
Linda B
LB
Kristinsdottir
2 University of Iceland, School of Health Sciences, Reykjavik, Iceland.
Erna S
ES
Oskarsdottir
2 University of Iceland, School of Health Sciences, Reykjavik, Iceland.
Steinar O
SO
Hafthorsson
3 Department of Clinical Biochemistry, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland.
Isleifur
I
Olafsson
2 University of Iceland, School of Health Sciences, Reykjavik, Iceland.
Sigrun H
SH
Lund
1 Department of Medicine, Division of Cardiology, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland.|2 University of Iceland, School of Health Sciences, Reykjavik, Iceland.
Karl
K
Andersen
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D001786:Blood Glucose / Q000378:metabolism*; D003325:Coronary Care Units; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D012372:ROC Curve; D015996:Survival Rate
D001786:Blood Glucose; D006442:Glycated Hemoglobin
Type 2 diabetes; acute coronary syndrome; cardiovascular disease(s); diagnosis; prediabetes