Is HBA1C reliable in diagnosing diabetes in the acute phase of acute coronary syndromes?

Stratinaki, Maria; Milaki, Kalliopi; Stavrakis, Stavros; Pitarokoilis, M; Charitakis, Emmanouil; Stavratis, S; Kafarakis, P; Garidas, G; Korela, Dafni; Katsiavos, A; Thanasia, A; Rogdakis, E; Lamprogiannakis, E; Foukarakis, E

doi:10.1093/ehjacc/zuab020.104

Cited by 2 publications

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“…(54) Moreover, evidence indicates a delay between the development of hyperglycemia and increasing HbA1c. (55) As a result, postpartum HbA1c may still reflect a proportion of third-trimester glycemia. In our study, the postpartum assessment occurred ten weeks (IQR 7-12) after delivery.…”

Section: Discussionmentioning

confidence: 99%

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Coetzee

Hall

Vyver

et al. 2023

Preprint

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Background: South African women of childbearing age are disproportionally affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). Unless pregnant, they do not readily undergo screening for T2DM. With a local focus on improved antenatal care, hyperglycemia is often first detected in pregnancy (HFDP). This may erroneously be attributed to Gestational Diabetes Mellitus (GDM) in all without considering T2DM. Glucose evaluation following pregnancy is essential for early detection and management of women with T2DM in whom persistent hyperglycemia is to be expected. Conventional testing with an oral glucose tolerance test (OGTT) is cumbersome, prompting investigation for alternate solutions. Aim: To compare the diagnostic performance of HbA1c to the current gold standard OGTT in women with HFDP 4-12 weeks post-delivery. Methods: Glucose homeostasis was assessed with OGTT and HbA1c in 167 women with HFDP, 4-12 weeks after delivery. Glucose status was based on American Diabetes Association criteria. Results: Glucose homeostasis was assessed at 10 weeks (IQR 7-12) after delivery. A total of 52/167 (31%) participants had hyperglycemia, 34 (20%) had prediabetes, and 18 (11%) had T2DM. For patients with prediabetes, fasting plasma glucose (FPG) and 2 hour plasma glucose (2hPG) were diagnostic in 12 patients, whereas in two-thirds (22/34) only one time point was diagnostic. FPG and 2hPG values were both in the prediabetes diagnostic range in six women with T2DM. Based on FPG, 15 women with persistent hyperglycemia (11 with prediabetes and four with T2DM) would have been missed (15/52; 29%). The HbA1c accurately classified 85% of the 52 participants with gold standard OGTT defined hyperglycemia and 15 of 18 women with postpartum persistent T2DM. When compared to an OGTT, a single HbA1c of 6.5% (48mmol/mol) postpartum demonstrated a sensitivity of 83% and specificity of 97% for the identification of T2DM. Conclusion: HbA1c may improve access to postpartum testing in overburdened clinical settings where the required standards of OGTT cannot be guaranteed. HbA1c is a valuable test to detect women who will benefit most from early intervention but cannot unequivocally replace OGTT.

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Section: Discussionmentioning

confidence: 99%

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Coetzee

Hall

Vyver

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The increased red cell turnover in pregnancy reduces glycation of hemoglobin and can lower HbA1c by as much as 0.5% in the third trimester [ 57 ]. Moreover, evidence indicates a delay between the development of hyperglycemia and increasing HbA1c [ 58 ]. As a result, postpartum HbA1c may still reflect a proportion of third-trimester glycemia.…”

Section: Discussionmentioning

confidence: 99%

Early postpartum HbA1c after hyperglycemia first detected in pregnancy—Imperfect but not without value

et al. 2023

View full text Add to dashboard Cite

Background South African women of childbearing age are disproportionally affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). Unless pregnant, they do not readily undergo screening for T2DM. With a local focus on improved antenatal care, hyperglycemia is often first detected in pregnancy (HFDP). This may erroneously be attributed to Gestational Diabetes Mellitus (GDM) in all without considering T2DM. Glucose evaluation following pregnancy is essential for early detection and management of women with T2DM in whom persistent hyperglycemia is to be expected. Conventional testing with an oral glucose tolerance test (OGTT) is cumbersome, prompting investigation for alternate solutions. Aim To compare the diagnostic performance of HbA1c to the current gold standard OGTT in women with HFDP 4–12 weeks post-delivery. Methods Glucose homeostasis was assessed with OGTT and HbA1c in 167 women with HFDP, 4–12 weeks after delivery. Glucose status was based on American Diabetes Association criteria. Results Glucose homeostasis was assessed at 10 weeks (IQR 7–12) after delivery. Of the 167 participants, 52 (31%) had hyperglycemia, which was comprised of 34 (20%) prediabetes and 18 (11%) T2DM. Twelve women in the prediabetes subgroup had diagnostic fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG), but in two-thirds of the patients (22/34) only one time point proved diagnostic. The FPGs and the 2hPGs of six women with HbA1c-based T2DM were both within the prediabetes diagnostic range. According to the HbA1c measurements, 85% of 52 participants with gold standard OGTT defined hyperglycemia (prediabetes and T2DM) as well as 15 of 18 women with postpartum persistent T2DM were correctly classified. According to FPG, 15 women with persistent hyperglycemia would have been missed (11 with prediabetes and four with T2DM; 29%). When compared to an OGTT, a single HbA1c of 6.5% (48mmol/mol) postpartum demonstrated a sensitivity of 83% and specificity of 97% for the identification of T2DM. Conclusion HbA1c may improve access to postpartum testing in overburdened clinical settings where the required standards of OGTT cannot be guaranteed. HbA1c is a valuable test to detect women who will benefit most from early intervention but cannot unequivocally replace OGTT.

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Is HBA1C reliable in diagnosing diabetes in the acute phase of acute coronary syndromes?

Cited by 2 publications

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Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Early postpartum HbA1c after hyperglycemia first detected in pregnancy—Imperfect but not without value

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