title: Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV.
abstract: WHO advocates 2-hour oral glucose tolerance test (OGTT) for detecting diabetes mellitus (DM). OGTT is the most sensitive method to detect DM in patients with coronary artery disease (CAD). Considered time consuming, the use of OGTT is unsatisfactory. A 1-hour plasma glucose (1hPG) test has not been evaluated as an alternative in patients with CAD.
  
  
  
  To create an algorithm based on glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 1hPG limiting the need of a 2-hour plasma glucose (2hPG) in patients with CAD.
  
  
  
  951 patients with CAD without DM underwent OGTT. A 2hPG≥11.1 mmol/L was the reference for undiagnosed DM. The yield of HbA1c, FPG and 1hPG was compared with that of 2hPG.
  
  
  
  Mean FPG was 6.2±0.9 mmol/L, and mean HbA1c 5.8±0.4%. Based on 2hPG≥11.1 mmol/L 122 patients (13%) had DM. There was no value for the combination of HbA1c and FPG to rule out or in DM (HbA1c≥6.5%; FPG≥7.0 mmol/L). In receiver operating characteristic analysis a 1hPG≥12 mmol/L balanced sensitivity and specificity for detecting DM (both=82%; positive and negative predictive values 40% and 97%). A combination of FPG<6.5 mmol/L and 1hPG<11 mmol/L excluded 99% of DM. A combination of FPG>8.0 mmol/L and 1hPG>15 mmol/L identified 100% of patients with DM.
  
  
  
  Based on its satisfactory accuracy to detect DM an algorithm is proposed for screening for DM in patients with CAD decreasing the need for a 2-hour OGTT by 71%.
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.|Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Viveca
authors.initials: V
authors.lastname: Gyberg
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Bacquer
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Kornelia
authors.initials: K
authors.lastname: Kotseva
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: De Backer
authors.affiliation: Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Schnell
authors.affiliation: Danube-University Krems, Krems, Austria.|Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.|Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.|Dasman Diabetes Institute, Kuwait City, Kuwait.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wood
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
mesh_terms: D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000150:complications*; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005060:Europe; D005215:Fasting; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis; D005951:Glucose Tolerance Test / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D012016:Reference Values; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes; Fasting Plasma Glucose; HbA1c; Oral Glucose Tolerance Test; Screening