Comparison of diagnostic criteria to detect undiagnosed diabetes in hyperglycaemic patients with acute coronary syndrome
Comparison of diagnostic criteria to detect undiagnosed diabetes in hyperglycaemic patients with acute coronary syndrome
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DOI：
10.1136/heartjnl-2011-300163
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发表时间：
2012-01-01
期刊：
影响因子：
5.7
通讯作者：
Umans, Victor A.
中科院分区：
文献类型：
--
作者：
de Mulder, Maarten;Oemrawsingh, Rohit M.;Umans, Victor A.
急性冠脉综合征（ACS）患者入院时血糖水平升高（APG）非常常见目的了解ACS患者中既往未诊断糖尿病的患病率，并比较不同的糖尿病诊断方法。方法参加BIOMArCS 2葡萄糖试验的ACS患者，出院前进行OGTT试验。纳入了130例接受代谢评估的患者。在这些国家中，109名患者有OGTT，13名患者有糖尿病。（以前）35%的患者未确诊糖尿病（空腹血糖（FPG）≥ 7.0 mmol/l或负荷后2小时血糖≥ 11.1 mmol/l）和44%的葡萄糖代谢受损（FPG 6.1-6.9 mmol/l或负荷后葡萄糖7.8-11.0 mmol/l），因此只有21%的人葡萄糖代谢正常。APG、FPG或HbA 1c不能充分预测未确诊的糖尿病（ROC曲线下面积分别为0.61、0.75和0.72）。与糖代谢正常的患者相比，糖代谢异常的患者年龄明显偏大，入院时HbA 1c值较高，Killip分级较高，既往中风的发生率更高。结论79%的ACS高血糖患者存在糖代谢异常。由于APG、HbA 1c和FPG检测未确诊糖尿病的敏感性较低，OGTT似乎是评估ACS高血糖患者是否存在既往未确诊糖尿病或糖代谢受损的最佳检测方法。
Background Elevated plasma glucose levels on admission (APG) are very common in patients with acute coronary syndrome (ACS) and can be the first indication of diabetes mellitus.Objective To provide insight into the prevalence of previously undiagnosed diabetes and to compare different methods of diagnosing diabetes in patients with ACS.Methods Patients with ACS with elevated APG who participated in the BIOMArCS 2 glucose trial underwent an oral glucose tolerance test (OGTT) prior to discharge. 130 patients were included who underwent metabolic assessment. Of these, 109 had an OGTT and 13 patients had pre-existing diabetes.Results The OGTT results were categorised as (previously) undiagnosed diabetes in 35% of patients (fasting plasma glucose (FPG) >= 7.0 mmol/l or 2-h post-load glucose >= 11.1 mmol/l) and impaired glucose metabolism in 44% (FPG 6.1-6.9 mmol/l or post-load glucose 7.8-11.0 mmol/l), so only 21% had a normal glucose metabolism. Undiagnosed diabetes could not be adequately predicted with APG, FPG or HbA1c (area under the ROC curve 0.61, 0.75 and 0.72, respectively). Patients with abnormal glucose metabolism were significantly older, had higher admission HbA1c values, a higher Killip classification and more often had a prior stroke than patients with normal glucose metabolism.Conclusion 79% of hyperglycaemic patients with ACS were found to have abnormal glucose metabolism. As APG, HbA1c and FPG had a low sensitivity to detect undiagnosed diabetes, an OGTT appears to be the best test to assess the presence of previously undiagnosed diabetes or impaired glucose metabolism in hyperglycaemic patients with ACS.