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Published in: Clinical Research in Cardiology 8/2012

01-08-2012 | Original Paper

Comparison of HbA1c and oral glucose tolerance test for diagnosis of diabetes in patients with coronary artery disease

Authors: Serdar Farhan, Rudolf Jarai, Ioannis Tentzeris, Alexandra Kautzky-Willer, Eslam Samaha, Peter Smetana, Gabriele Jakl-Kotauschek, Johann Wojta, Kurt Huber

Published in: Clinical Research in Cardiology | Issue 8/2012

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Abstract

Background

Measurement of glycated hemoglobin A1c (HbA1c) to diagnose diabetes mellitus (DM-2) is recommended by several expert groups. DM-2 occurs very frequently among patients with coronary artery disease (CAD). Therefore, we aimed to investigate the diagnostic strengths of HbA1c and oral glucose tolerance test (OGTT) in detecting latent glucometabolic disturbances among patients with CAD.

Materials and methods

One hundred ninety-nine consecutive patients admitted with CAD were included in this observational study. Fasting plasma glucose as well as HbA1c measurement was performed in all study participants and those without preexisting DM-2 underwent an OGTT.

Results

Patients were subdivided according to their medical history into those with previous DM-2 (n = 37). The remaining 162 patients underwent OGTT, which revealed 39 patients with diabetes (DM-OGTT), 35 with impaired glucose tolerance (IGT), 20 with impaired fasting glucose (IFG) and 68 with normal glucose tolerance (NGT). Using HbA1c resulted in 6.8% DM and 45.6% at risk (HbA1c 5.7–6.4%) diagnosis. OGTT identified 24.1% DM (p = 0.002 compared with HbA1c) and 21.6% IGT patients. Among those with intermediate HbA1c (5.7–6.4%) 26.5% patients were NGT and only 30.9% displayed DM-2 by use of OGTT. Among patients with HbA1c of <5.7%, 44% (n = 31) of patients had disturbed glucose metabolism. Using receiver-operating curve HbA1c cutoff with the highest sensitivity and specificity was found to be 5.8%.

Discussion

There is a large discordance between OGTT and HbA1c in terms of detecting latent DM-2 in patients with CAD. Measurement of HbA1c could result in lower propensity of DM-2 diagnosis.
Literature
1.
go back to reference Kannel WB, McGee DL (1979) Diabetes and cardiovascular disease. The Framingham study. JAMA 241:2035–2038PubMedCrossRef Kannel WB, McGee DL (1979) Diabetes and cardiovascular disease. The Framingham study. JAMA 241:2035–2038PubMedCrossRef
2.
go back to reference Dziewierz A, Giszterowicz D, Siudak Z, Rakowski T, Dubiel JS, Dudek D (2010) Admission glucose level and in-hospital outcomes in diabetic and non-diabetic patients with acute myocardial infarction. Clin Res Cardiol 99:715–721PubMedCrossRef Dziewierz A, Giszterowicz D, Siudak Z, Rakowski T, Dubiel JS, Dudek D (2010) Admission glucose level and in-hospital outcomes in diabetic and non-diabetic patients with acute myocardial infarction. Clin Res Cardiol 99:715–721PubMedCrossRef
3.
go back to reference Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234PubMedCrossRef Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234PubMedCrossRef
4.
go back to reference Bartnik M, Ryden L, Ferrari R, Malmberg K, Pyorala K, Simoons M, Standl E, Soler–Soler J, Ohrvik J (2004) The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 25:1880–1890PubMedCrossRef Bartnik M, Ryden L, Ferrari R, Malmberg K, Pyorala K, Simoons M, Standl E, Soler–Soler J, Ohrvik J (2004) The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 25:1880–1890PubMedCrossRef
5.
go back to reference Hu DY, Pan CY, Yu JM (2006) The relationship between coronary artery disease and abnormal glucose regulation in China: The China Heart Survey. Eur Heart J 27:2573–2579PubMedCrossRef Hu DY, Pan CY, Yu JM (2006) The relationship between coronary artery disease and abnormal glucose regulation in China: The China Heart Survey. Eur Heart J 27:2573–2579PubMedCrossRef
6.
go back to reference Wascher TC, Sourij H, Roth M, Dittrich P (2004) Prevalence of pathological glucose metabolism in patients undergoing elective coronary angiography. Atherosclerosis 176:419–421PubMedCrossRef Wascher TC, Sourij H, Roth M, Dittrich P (2004) Prevalence of pathological glucose metabolism in patients undergoing elective coronary angiography. Atherosclerosis 176:419–421PubMedCrossRef
7.
go back to reference American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(Suppl 1):S62–S69CrossRef American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(Suppl 1):S62–S69CrossRef
8.
go back to reference International Expert Committee (2009) International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 32:1327–1334CrossRef International Expert Committee (2009) International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 32:1327–1334CrossRef
9.
go back to reference World Health Organization and International Diabetes Federation (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. World Health Organization, Geneva World Health Organization and International Diabetes Federation (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. World Health Organization, Geneva
10.
go back to reference Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetes Med 15:539–553CrossRef Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetes Med 15:539–553CrossRef
11.
go back to reference Olson DE, Rhee MK, Herrick K, Ziemer DC, Twombly JG, Phillips LS (2010) Screening for diabetes and prediabetes with proposed A1c-based diagnostic criteria. Diabetes Care 33:2184–2189PubMedCrossRef Olson DE, Rhee MK, Herrick K, Ziemer DC, Twombly JG, Phillips LS (2010) Screening for diabetes and prediabetes with proposed A1c-based diagnostic criteria. Diabetes Care 33:2184–2189PubMedCrossRef
12.
go back to reference Lorenzo C, Wagenknecht LE, Hanley AJ, Rewers MJ, Karter AJ, Haffner SM (2010) Hemoglobin A1c between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: the insulin resistance atherosclerosis study (IRAS). Diabetes Care 33:2104–2109PubMedCrossRef Lorenzo C, Wagenknecht LE, Hanley AJ, Rewers MJ, Karter AJ, Haffner SM (2010) Hemoglobin A1c between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: the insulin resistance atherosclerosis study (IRAS). Diabetes Care 33:2104–2109PubMedCrossRef
13.
go back to reference Kramer CK, Araneta MR, Barrett-Connor E (2010) A1C and diabetes diagnosis: the Rancho Bernardo study. Diabetes Care 33:101–103PubMedCrossRef Kramer CK, Araneta MR, Barrett-Connor E (2010) A1C and diabetes diagnosis: the Rancho Bernardo study. Diabetes Care 33:101–103PubMedCrossRef
14.
go back to reference Buell C, Kermah D, Davidson MB (2007) Utility of A1C for diabetes screening in the 1999 2004 NHANES population. Diabetes Care 30:2233–2235PubMedCrossRef Buell C, Kermah D, Davidson MB (2007) Utility of A1C for diabetes screening in the 1999 2004 NHANES population. Diabetes Care 30:2233–2235PubMedCrossRef
15.
go back to reference van’t Riet E, Alssema M, Rijkelijkhuizen JM, Kostense PJ, Nijpels G, Dekker JM (2010) Relationship between A1C and glucose levels in the general Dutch population: the new Hoorn study. Diabetes Care 33:61–66CrossRef van’t Riet E, Alssema M, Rijkelijkhuizen JM, Kostense PJ, Nijpels G, Dekker JM (2010) Relationship between A1C and glucose levels in the general Dutch population: the new Hoorn study. Diabetes Care 33:61–66CrossRef
16.
go back to reference Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516PubMedCrossRef Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516PubMedCrossRef
17.
go back to reference Tekumit H, Cenal AR, Polat A, Uzun K, Tataroglu C, Akinci E (2010) Diagnostic value of hemoglobin A1c and fasting plasma glucose levels in coronary artery bypass grafting patients with undiagnosed diabetes mellitus. Ann Thorac Surg 89:1482–1487PubMedCrossRef Tekumit H, Cenal AR, Polat A, Uzun K, Tataroglu C, Akinci E (2010) Diagnostic value of hemoglobin A1c and fasting plasma glucose levels in coronary artery bypass grafting patients with undiagnosed diabetes mellitus. Ann Thorac Surg 89:1482–1487PubMedCrossRef
18.
go back to reference Bao Y, Ma X, Li H, Zhou M, Hu C, Wu H, Tang J, Hou X, Xiang K, Jia W (2010) Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey. BMJ 340:c2249PubMedCrossRef Bao Y, Ma X, Li H, Zhou M, Hu C, Wu H, Tang J, Hou X, Xiang K, Jia W (2010) Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey. BMJ 340:c2249PubMedCrossRef
19.
go back to reference Boavida JM, Gardete-Correia L, Massano-Cardoso S, Mesquita C, Raposo JF (2010) Hemoglobin A1c in a population with pre-diabetes, diagnosed and previously undiagnosed diabetes. Diabetologia 53:S87 Boavida JM, Gardete-Correia L, Massano-Cardoso S, Mesquita C, Raposo JF (2010) Hemoglobin A1c in a population with pre-diabetes, diagnosed and previously undiagnosed diabetes. Diabetologia 53:S87
20.
go back to reference Cosson E, Nguyen M, Hamo Tchatchouang E, Banu I, Chiheb S, Valensi P (2010) Diagnosis of abnormal glucose levels in patients at high risk for the development of diabetes: a comparison of the oral glucose tolerance test and measurement of HbA1c following the American Diabetes Association recommendations 2010. Diabetologia 53:S87 Cosson E, Nguyen M, Hamo Tchatchouang E, Banu I, Chiheb S, Valensi P (2010) Diagnosis of abnormal glucose levels in patients at high risk for the development of diabetes: a comparison of the oral glucose tolerance test and measurement of HbA1c following the American Diabetes Association recommendations 2010. Diabetologia 53:S87
21.
go back to reference Delgado E, De la Hera JM, Lozano I, Hernandez E, Vegas JM, Fernandez-Cimadevilla C, Torres F, Carro A, Bayon J, Garcia-Ruiz JM, Avanzas P (2010) Detection of diabetes in coronary artery disease: oral glucose tolerance test or glycated haemoglobin and fasting plasma glucose? Diabetologia 53:S159 Delgado E, De la Hera JM, Lozano I, Hernandez E, Vegas JM, Fernandez-Cimadevilla C, Torres F, Carro A, Bayon J, Garcia-Ruiz JM, Avanzas P (2010) Detection of diabetes in coronary artery disease: oral glucose tolerance test or glycated haemoglobin and fasting plasma glucose? Diabetologia 53:S159
22.
go back to reference Koehler C, Henkel E, Schaper F, Hanefeld M (2010) The HbA1c cut points for detecting type 2 diabetes and prediabetes in a risk population—is this the right way? Diabetologia 53:S158 Koehler C, Henkel E, Schaper F, Hanefeld M (2010) The HbA1c cut points for detecting type 2 diabetes and prediabetes in a risk population—is this the right way? Diabetologia 53:S158
23.
go back to reference Sourij H, Saely CH, Schmid F, Zweiker R, Marte T, Wascher TC, Drexel H (2010) Post-challenge hyperglycaemia is strongly associated with future macrovascular events and total mortality in angiographied coronary patients. Eur Heart J 31(13):1583–1590PubMedCrossRef Sourij H, Saely CH, Schmid F, Zweiker R, Marte T, Wascher TC, Drexel H (2010) Post-challenge hyperglycaemia is strongly associated with future macrovascular events and total mortality in angiographied coronary patients. Eur Heart J 31(13):1583–1590PubMedCrossRef
24.
go back to reference Unwin N, Shaw J, Zimmet P, Alberti KG (2002) Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabetes Med 19:708–723CrossRef Unwin N, Shaw J, Zimmet P, Alberti KG (2002) Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabetes Med 19:708–723CrossRef
25.
go back to reference Preiss D, Welsh P, Murray HM, Shepherd J, Packard C, Macfarlane P, Cobbe S, Ford I, Sattar N (2010) Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up. Eur Heart J 31:1230–1236PubMedCrossRef Preiss D, Welsh P, Murray HM, Shepherd J, Packard C, Macfarlane P, Cobbe S, Ford I, Sattar N (2010) Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up. Eur Heart J 31:1230–1236PubMedCrossRef
26.
go back to reference Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, Cosentino F, Jonsson B, Laakso M, Malmberg K, Priori S, Ostergren J, Tuomilehto J, Thrainsdottir I, Vanhorebeek I, Stramba-Badiale M, Lindgren P, Qiao Q, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL, Deckers JW, Bertrand M, Charbonnel B, Erdmann E, Ferrannini E, Flyvbjerg A, Gohlke H, Juanatey JR, Graham I, Monteiro PF, Parhofer K, Pyorala K, Raz I, Schernthaner G, Volpe M, Wood D (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The task force on diabetes and cardiovascular diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 28:88–136PubMedCrossRef Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, Cosentino F, Jonsson B, Laakso M, Malmberg K, Priori S, Ostergren J, Tuomilehto J, Thrainsdottir I, Vanhorebeek I, Stramba-Badiale M, Lindgren P, Qiao Q, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL, Deckers JW, Bertrand M, Charbonnel B, Erdmann E, Ferrannini E, Flyvbjerg A, Gohlke H, Juanatey JR, Graham I, Monteiro PF, Parhofer K, Pyorala K, Raz I, Schernthaner G, Volpe M, Wood D (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The task force on diabetes and cardiovascular diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 28:88–136PubMedCrossRef
27.
go back to reference Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 359:2072–2077PubMedCrossRef Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 359:2072–2077PubMedCrossRef
28.
go back to reference Knudsen EC, Seljeflot I, Abdelnoor M, Eritsland J, Mangschau A, Arnesen H, Andersen GO (2009) Abnormal glucose regulation in patients with acute ST-elevation myocardial infarction—a cohort study on 224 patients. Cardiovasc Diabetol 8:6PubMedCrossRef Knudsen EC, Seljeflot I, Abdelnoor M, Eritsland J, Mangschau A, Arnesen H, Andersen GO (2009) Abnormal glucose regulation in patients with acute ST-elevation myocardial infarction—a cohort study on 224 patients. Cardiovasc Diabetol 8:6PubMedCrossRef
29.
go back to reference Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendic S, Ryden L, Malmberg K (2002) Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 359:2140–2144PubMedCrossRef Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendic S, Ryden L, Malmberg K (2002) Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 359:2140–2144PubMedCrossRef
Metadata
Title
Comparison of HbA1c and oral glucose tolerance test for diagnosis of diabetes in patients with coronary artery disease
Authors
Serdar Farhan
Rudolf Jarai
Ioannis Tentzeris
Alexandra Kautzky-Willer
Eslam Samaha
Peter Smetana
Gabriele Jakl-Kotauschek
Johann Wojta
Kurt Huber
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Clinical Research in Cardiology / Issue 8/2012
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-012-0435-3

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