Oral glucose tolerance test is needed for appropriate classification of glucose regulation in patients with coronary artery disease:: a report from the Euro Heart Survey on Diabetes and the Heart
Oral glucose tolerance test is needed for appropriate classification of glucose regulation in patients with coronary artery disease:: a report from the Euro Heart Survey on Diabetes and the Heart
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DOI：
10.1136/hrt.2005.086975
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发表时间：
2007-01-01
期刊：
影响因子：
5.7
通讯作者：
Soler-Soler, J.
中科院分区：
文献类型：
--
作者：
Bartnik, M.;Ryden, L.;Soler-Soler, J.
背景资料：冠心病（coronary artery disease，CAD）合并糖调节异常（angiogram regulation，AGR）的患者是心血管事件的高危人群，因此对冠心病患者进行准确的糖代谢评估具有重要的临床意义。在25个国家的110个中心前瞻性招募了转诊至心脏病专家的连续性患者（n = 4961）。要求无已知血糖异常的患者（n = 3362）在75 g葡萄糖负荷后2 h进行空腹血糖（FPG）和高血糖检查。根据世界卫生组织和美国糖尿病协会对糖代谢进行分类（ADA; 1997，2004）标准为正常、空腹血糖受损（IFG）、糖耐量受损（IGT）或糖尿病。1867例患者的FPG和2小时负荷后高血糖数据可用，其中870例（47%）血糖调节正常，87例（5%）IFG，IGT 591例（32%），糖尿病319例（17%）。如果分类基于1997年的ADA标准，则错误分类（诊断不足）的患者比例为39%。ADA 2004标准将有8%的患者过度诊断，33%的患者诊断不足，导致总的错误分类率为41%。出于伦理和实际原因，1495例合格患者未进行口服葡萄糖耐量试验（OGTT）。这些患者通常是女性，年龄和腰围更大，因此比纳入的患者更有可能患有AGR。一个模型的基础上容易获得的临床和实验室变量，包括FPG，高密度脂蛋白胆固醇，年龄和糖化血红蛋白A1 C的对数，错误分类44%的患者，其中18%被过度诊断和26%被underdiagnosed.Conclusion：OGTT仍然是最合适的方法，用于临床评估糖代谢状态的冠心病患者。
Background: Patients with coronary artery disease ( CAD) and abnormal glucose regulation ( AGR) are at high risk for subsequent cardiovascular events, underlining the importance of accurate glucometabolic assessment in clinical practice.Objective: To investigate different methods to identify glucose disturbances among patients with acute and stable coronary heart disease.Methods: Consecutive patients referred to cardiologists were prospectively enrolled at 110 centres in 25 countries ( n = 4961). Fasting plasma glucose ( FPG) and glycaemia 2 h after a 75-g glucose load were requested in patients without known glucose abnormalities ( n = 3362). Glucose metabolism was classified according to the World Health Organization and American Diabetes Association ( ADA; 1997, 2004) criteria as normal, impaired fasting glucose ( IFG), impaired glucose tolerance ( IGT) or diabetes.Results: Data on FPG and 2-h post-load glycaemia were available for 1867 patients, of whom 870 ( 47%) had normal glucose regulation, 87 ( 5%) had IFG, 591 ( 32%) had IGT and 319 ( 17%) had diabetes. If classification had been based on the ADA criterion from 1997, the proportion of misclassified ( underdiagnosed) patients would have been 39%. The ADA 2004 criterion would have overdiagnosed 8% and underdiagnosed 33% of the patients, resulting in a total misclassification rate of 41%. For ethical concerns and practical reasons, oral glucose tolerance test ( OGTT) was not conducted in 1495 of eligible patients. These patients were more often women, had higher age and waist circumference, and were therefore more likely to have AGR than those who were included. A model based on easily available clinical and laboratory variables, including FPG, high-density lipoprotein cholesterol, age and the logarithm of glycated haemoglobin A1c, misclassified 44% of the patients, of whom 18% were overdiagnosed and 26% were underdiagnosed.Conclusion: An OGTT is still the most appropriate method for the clinical assessment of glucometabolic status in patients with coronary heart disease.