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Can Admission and Fasting Glucose Reliably Identify Undiagnosed Diabetes in Patients With Acute Coronary Syndrome?

Okosieme, Onyebuchi E., Peter, Rajesh, Usman, Muhammad, Bolusani, Hemanth, Suruliram, P., George, L. and Evans, Lyndon Marc 2008. Can Admission and Fasting Glucose Reliably Identify Undiagnosed Diabetes in Patients With Acute Coronary Syndrome? Diabetes Care 31 (10) , pp. 1955-1959. 10.2337/dc08-0197

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Objective: Our objectives were: (1) to determine the prevalence of previously undiagnosed abnormal glucose tolerance i.e. diabetes and impaired glucose tolerance (IGT) in patients with acute coronary syndrome, and (2) to assess the utility of admission and fasting glucose in identifying diabetes in these patients. Research Design and Methods: Glycaemic status was characterised based on admission plasma glucose (APG), fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) in 140 patients admitted to hospital with acute coronary syndrome who were not known to have diabetes (mean age 67.3 ± 13.4 years; males 79%). OGTTs were performed on days 5-7 following admission. Results: The prevalence of diabetes and IGT was 27% and 39% respectively according to OGTT criteria. Receiver operating characteristics (ROC) curves showed that the area under the curve (AUC) for diagnosing diabetes was 0.83 (p<0.001) for FPG, 0.79 (P<.001) for admission glucose and 0.84 (p<0.001) for fasting and admission glucose applied in combination. A fasting glucose cutoff ≥ 5.6 mmol/L (100 mg/dl) and/or admission glucose ≥ 7.8 mmol/L (140 mg/dl) yielded a sensitivity of 89.5% and a positive predictive value of 43.6% for detecting diabetes. Conclusions: A high prevalence of abnormal glucose tolerance was seen in patients with acute coronary syndrome. The combination of FPG ≥5.6 mmol/L (100 mg/dl) and/or APG ≥ 7.8 mmol/L (140 mg/dl) was highly sensitive for identifying diabetes. Although weakly specific, this simple algorithm could offer a practical initial screening tool at the acute setting in the high risk acute coronary syndrome population.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: American Diabetes Association
ISSN: 0149-5992
Last Modified: 09 Nov 2019 00:08

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