[Performance of glycated hemoglobin and a risk model for detection of unknown diabetes in coronary patients].

Abstract

INTRODUCTION AND OBJECTIVES:

Traditionally, the oral glucose tolerance test has been useful to diagnose unknown diabetes. Recently, the American Diabetes Association committee has accepted glycated hemoglobin ≥ 6.5% as a criterion for unknown diabetes. The aim was to determine the benefit of glycated hemoglobin for diagnosing unknown diabetes and also create a predictive model that adjusts the indication for oral glucose tolerance test in coronary patients.

METHODS:

We examined the glycemic profile of 338 coronary patients without previous diagnosis of diabetes, applying 2010 American Diabetes Association criteria. A unknown diabetes risk predictive model was developed using logistic regression analysis, and then validated in another cohort.

RESULTS:

Using the glycated hemoglobin criteria and/or fasting plasma glucose, unknown diabetes was diagnosed in 26 patients. The remaining patients were classified according to oral glucose tolerance test as follows: unknown diabetes 53 (17%), prediabetes 144 (46.2%), and normoglycemic 115 (36.8%). The diagnostic method for unknown diabetes was fasting plasma glucose in 25.3%, glycated hemoglobin in 7.6%, and oral glucose tolerance test in 67.1%. A risk model including fasting plasma glucose, glycated hemoglobin, left ventricular ejection fraction, age, and noncoronary vascular disease was shown to effectively predict unknown diabetes after oral glucose tolerance test: area under the ROC curve 0.8 (95% confidence interval: 0.74-0.87). When the oral glucose tolerance test is restricted to patients with a risk score >6 (31% of our sample) we properly identify 83% of unknown diabetes cases (sensitivity: 75%, specificity: 73%, positive predictive value: 40%, negative predictive value: 93%). The model was adequately validated in another cohort of 115 patients (area under the ROC curve 0.84 [95% confidence interval: 0.74-0.95]).

CONCLUSIONS:

In coronary patients, glycated hemoglobin alone failed to detect many cases of unknown diabetes. However, its inclusion in a risk prediction model leads to optimizing the usefulness of oral glucose tolerance test.

• Authors: Jesús M de la Hera, José M Vegas, Ernesto Hernández, Iñigo Lozano, José M García-Ruiz, Oliva C Fernández-Cimadevilla, Amelia Carro, Pablo Avanzas, Francisco Torres, Jeremías Bayón, Teresa Menéndez, Manuel Jiménez-Navarro, Elías Delgado
• Journal: Revista espanola de cardiologia (Rev Esp Cardiol) Vol. 64 Issue 9 Pg. 759-65 (Sep 2011) ISSN: 1579-2242 [Electronic] Spain
• Vernacular Title: Rendimiento de la glucohemoglobina y un modelo de riesgo para la detección de diabetes desconocida en pacientes coronarios.
• PMID: 21752514 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Blood Glucose (analysis)
• Cohort Studies
• Coronary Disease (complications)
• Diabetes Mellitus (diagnosis)
• Female
• Glucose Tolerance Test
• Glycated Hemoglobin (analysis)
• Humans
• Male
• Middle Aged
• Models, Statistical
• Multivariate Analysis
• Prediabetic State (diagnosis)
• Predictive Value of Tests
• Reproducibility of Results
• Risk Assessment