title: HbA1cscreening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?
abstract: BACKGROUND
  Diabetes and pre-diabetes are prevalent in acute coronary syndrome (ACS) and relate to adverse outcomes. This study used HbA1cto screen for degrees of glucose intolerance amongst patients without known diabetes presenting with ACS.
  
  
  METHODS
  Over a 1-year period (June 2014-2015) consecutive patients admitted to a single centre cardiology unit with an initial diagnosis of ACS without prior diabetes diagnosis were electronically referred to our diabetes team. Patients were screened for the presence of diabetes by use of an initial HbA1cblood test on day 2 or 3 post admission. If abnormal (≥42 mmol/mol; ≥6.0%), patients were invited for a repeat HbA1cat 2 weeks, and if an intermediate result (42-47 mmol/mol; 6.0-6.4%), for an oral glucose tolerance test (OGTT) at 3 months. Patients were diagnosed with Type 2 diabetes if the repeat HbA1cresult was high (≥48 mmol/mol; ≥6.5%) or the OGTT at 3 months confirmed the diagnosis. Other data collected included baseline demographics, risk factors and any history of cardiovascular disease. All patients with ACS were stratified according to the diagnosis and subsequent management.
  
  
  RESULTS
  We screened 399 patients in total. The mean age was 65 ± 14 years, 268 (67%) were men, 290 (73%) were Caucasian, 95 (24%) were South Asian and 14 (4%) were Afro-Caribbean ethnicity. Of all patients, 57 (14.3%) were diagnosed as pre-diabetes and 43 (10.8%) newly diagnosed diabetes. During the study 28 (7%) patients could not be classified; 6 (1.5%) patients died during the study and 22 (5.5%) patients were missing either initial or repeat HbA1cand were subsequently lost to follow up. Of the baseline variables assessed, there were significantly more patients of South Asian ethnicity in the diabetes group compared to the normal group (42 vs 20%;p= 0.003). There was no difference in detection rates in patients with more severe ACS requiring percutaneous or cardiac surgical intervention.
  
  
  CONCLUSIONS
  The use of a simple HbA1cscreening method in clinical practice can detect new onset diabetes in approximately 1 in 10 high-risk post ACS patients.
authors.affiliation: Department of Diabetes & Endocrinology, City Hospital Birmingham, Sandwell & West Birmingham NHS Trust, Birmingham, UK.|Institute of Inflammation and Ageing, Center for Translational Inflammation Research, University of Birmingham, Birmingham, UK.
authors.forename: Sebastian T
authors.initials: ST
authors.lastname: Lugg
authors.affiliation: Department of Diabetes & Endocrinology, City Hospital Birmingham, Sandwell & West Birmingham NHS Trust, Birmingham, UK.
authors.forename: Christine J H
authors.initials: CJH
authors.lastname: May
authors.affiliation: Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.affiliation: Department of Diabetes & Endocrinology, City Hospital Birmingham, Sandwell & West Birmingham NHS Trust, Birmingham, UK.
authors.forename: Robbie P E
authors.initials: RPE
authors.lastname: Tuffley
authors.affiliation: Department of Diabetes & Endocrinology, City Hospital Birmingham, Sandwell & West Birmingham NHS Trust, Birmingham, UK.
authors.forename: June
authors.initials: J
authors.lastname: Al-Hourani
authors.affiliation: Department of Diabetes & Endocrinology, City Hospital Birmingham, Sandwell & West Birmingham NHS Trust, Birmingham, UK.
authors.forename: Parijat
authors.initials: P
authors.lastname: De
keywords: Acute coronary syndrome; HbA1c; Pre-diabetes; Type 2 diabetes