A simple strategy for screening for glucose intolerance, using glycated haemoglobin, in individuals admitted with acute coronary syndrome

Gholap, Nitin; Davies, Melanie J.; Mostafa, Samiul; Squire, Iain B.; Khunti, Kamlesh

doi:10.1111/j.1464-5491.2012.03643.x

Cited by 18 publications

(11 citation statements)

References 22 publications

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“…HbA 1c has also been shown to independently predict glucose intolerance at 3 months in patients admitted with ACS without known diabetes [odds ratio (95% CI): 2.58 (1.17–6.09) p = 0.024], and correlates with 2hPG and OGTT [16]. We repeated the HbA 1c at 2 weeks, although this has been previously recommended at 4–8 weeks mainly on logistical grounds, fully recognising that a one-off test would have perhaps been sufficient for diagnostic purposes [10]. We found that repeat testing at 2 weeks was feasible, practical and a reassuring test to confirm the diagnosis and promptly inform patients of the diagnosis of potential glucose abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with an intermediate or high initial HbA 1c were invited for a repeat HbA 1c at 2 weeks as per American Diabetes Association guidelines to confirm diagnosis of Type 2 diabetes for those with high levels [13]. Patients with a repeat HbA 1c within intermediate range were further categorised by an OGTT at 3 months as previously recommended [10]. This was a standardised 75-g OGTT, performed in the morning, after a 12-h overnight fast, and results were defined as normal, impaired or consistent with diabetes diagnosis, according to the WHO 1998 definitions [14].…”

Section: Methodsmentioning

confidence: 99%

“…The National Institute of Health and Care Excellence (NICE) recommend that all ACS patients with admission blood glucose concentrations above 11.0 mmol/l should have FPG no earlier than day 4 after ACS onset or have an HbA 1c test before discharge [9]. A screening strategy using HbA 1c as the preferred test would be pragmatic and improve early detection and management of glucose intolerance in acute cardiology care practice [10–12]. …”

Section: Introductionmentioning

confidence: 99%

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HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

Lugg

May²,

Tuffley³

et al. 2017

J Diabetes Metab Disord

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BackgroundDiabetes and pre-diabetes are prevalent in acute coronary syndrome (ACS) and relate to adverse outcomes. This study used HbA1c to screen for degrees of glucose intolerance amongst patients without known diabetes presenting with ACS.MethodsOver 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 HbA1c blood test on day 2 or 3 post admission. If abnormal (≥42 mmol/mol; ≥6.0%), patients were invited for a repeat HbA1c at 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 HbA1c result 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.ResultsWe 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 HbA1c and 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.ConclusionsThe use of a simple HbA1c screening method in clinical practice can detect new onset diabetes in approximately 1 in 10 high-risk post ACS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

Lugg

May²,

Tuffley³

et al. 2017

J Diabetes Metab Disord

View full text Add to dashboard Cite

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“…Owing to this attempts to construct algorithms to limit the use of OGTT have been made. An algorithm combining FPG and HbA1c limited the use of OGTT in people with impaired fasting glucose (IFG),15 and Gholap et al 16 presented an algorithm based on HbA1c in patients with acute coronary syndromes. Both these studies based their cut point on ‘pragmatic’ grounds due to limited availability of actual data 16.…”

Section: Introductionmentioning

confidence: 99%

“…An algorithm combining FPG and HbA1c limited the use of OGTT in people with impaired fasting glucose (IFG),15 and Gholap et al 16 presented an algorithm based on HbA1c in patients with acute coronary syndromes. Both these studies based their cut point on ‘pragmatic’ grounds due to limited availability of actual data 16. A 1-hour plasma glucose (1hPG) test has been suggested as a time-saving option, still retaining reasonably good accuracy in detecting type 2 DM when screening high-risk individuals in a general population 17…”

Section: Introductionmentioning

confidence: 99%

Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV

et al. 2016

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BackgroundWHO 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.ObjectivesTo 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.Methods951 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.ResultsMean 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.ConclusionsBased 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%.

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Diabetes and Cardiovascular Disease

Coutiño-Castelán

Abundes-Velasco

Santos

et al. 2019

The Diabetes Textbook

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A simple strategy for screening for glucose intolerance, using glycated haemoglobin, in individuals admitted with acute coronary syndrome

Cited by 18 publications

References 22 publications

HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV

Diabetes and Cardiovascular Disease

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