Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c: a report from EUROASPIRE IV—a survey from the European Society of Cardiology

Gyberg, Viveca; Bacquer, Dirk De; Kotseva, Kornelia; Backer, Guy De; Schnell, Oliver; Sundvall, Jouko; Tuomilehto, Jaakko; Wood, David; Rydén, Lars

doi:10.1093/eurheartj/ehv008

Cited by 90 publications

(73 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…25 These studies did not include a population of patients with verified CAD. The recent report from EUROASPIRE IV demonstrated that screening coronary patients with HbA1c, and FPG alone left one in five patients with undetected DM 9. Yet, this combination alone has been advocated as sufficient for diagnosing DM in patients with CAD 26…”

Section: Discussionmentioning

confidence: 99%

“…Details of EUROASPIRE IV, conducted in 24 European countries from May 2012 to April 2013, have been presented elsewhere 9. This description relates to details of special interest for the present study.…”

Section: Methodsmentioning

confidence: 99%

“…10–14 A report from EUROASPIRE IV demonstrated that OGTT was the most sensitive test when screening for DM in patients with CAD while FPG in combination with HbA1c left about a fifth of patients with DM unidentified 9. A disadvantage with an OGTT is that it is time consuming in comparison with the single blood test needed for a FPG or HbA1c.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundWHO advocates 2-hour oral glucose tolerance test (OGTT) for detecting diabetes mellitus (DM). OGTT is the most sensitive method to detect DM in patients with coronary artery disease (CAD). Considered time consuming, the use of OGTT is unsatisfactory. A 1-hour plasma glucose (1hPG) test has not been evaluated as an alternative in patients with CAD.ObjectivesTo create an algorithm based on glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 1hPG limiting the need of a 2-hour plasma glucose (2hPG) in patients with CAD.Methods951 patients with CAD without DM underwent OGTT. A 2hPG≥11.1 mmol/L was the reference for undiagnosed DM. The yield of HbA1c, FPG and 1hPG was compared with that of 2hPG.ResultsMean FPG was 6.2±0.9 mmol/L, and mean HbA1c 5.8±0.4%. Based on 2hPG≥11.1 mmol/L 122 patients (13%) had DM. There was no value for the combination of HbA1c and FPG to rule out or in DM (HbA1c≥6.5%; FPG≥7.0 mmol/L). In receiver operating characteristic analysis a 1hPG≥12 mmol/L balanced sensitivity and specificity for detecting DM (both=82%; positive and negative predictive values 40% and 97%). A combination of FPG<6.5 mmol/L and 1hPG<11 mmol/L excluded 99% of DM. A combination of FPG>8.0 mmol/L and 1hPG>15 mmol/L identified 100% of patients with DM.ConclusionsBased on its satisfactory accuracy to detect DM an algorithm is proposed for screening for DM in patients with CAD decreasing the need for a 2-hour OGTT by 71%.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…During ORIGINALE, incident diabetes was diagnosed by means of the HbA 1c level, which is a less sensitive test than the oral glucose tolerance test used in ORIGIN (11). Nevertheless, when incident cases of confirmed diabetes that developed during ORIGINALE (after insulin was discontinued for all participants without diabetes at the end of the trial) were added to those identified during ORIGIN, there was a consistent (albeit nonsignificant) 5% reduction in newly developed diabetes that achieved significance when 69 possible but unconfirmed cases of diabetes were added.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and Other Outcomes Postintervention With Insulin Glargine and Omega-3 Fatty Acids (ORIGINALE)

Investigators¹

2015

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVEThe Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial reported neutral effects of insulin glargine on cardiovascular outcomes and cancers and reduced incident diabetes in high-cardiovascular risk adults with dysglycemia after 6.2 years of active treatment. Omega-3 fatty acids had neutral effects on cardiovascular outcomes. The ORIGIN and Legacy Effects (ORIGINALE) study measured posttrial effects of these interventions during an additional 2.7 years. RESEARCH DESIGN AND METHODSSurviving ORIGIN participants attended up to two additional visits. The hazard of clinical outcomes during the entire follow-up period from randomization was calculated. RESULTSOf 12,537 participants randomized, posttrial data were analyzed for 4,718 originally allocated to insulin glargine (2,351) versus standard care (2,367), and 4,771 originally allocated to omega-3 fatty acid supplements (2,368) versus placebo (2,403). Posttrial, small differences in median HbA 1c persisted (glargine 6.6% [49 mmol/mol], standard care 6.7% [50 mmol/mol], P = 0.025). From randomization to the end of posttrial follow-up, no differences were found between the glargine and standard care groups in myocardial infarction, stroke, or cardiovascular death (1,185 vs. 1,165 events; hazard ratio 1.01 [95% CI 0.94-1.10]; P = 0.72); myocardial infarction, stroke, cardiovascular death, revascularization, or hospitalization for heart failure (1,958 vs. 1,910 events; 1.03 [0.97-1.10]; P = 0.38); or any cancer (524 vs. 529 events; 0.99 [0.88-1.12]; P = 0.91) or between omega-3 and placebo groups in cardiovascular death (688 vs. 700; 0.98 [0.88-1.09]; P = 0.68) or other outcomes. CONCLUSIONSDuring >6 years of treatment followed by >2.5 years of observation, insulin glargine had neutral effects on health outcomes and salutary effects on metabolic control, whereas omega-3 fatty acid supplementation had no effect.Type 2 diabetes is a strong, independent risk factor for myocardial infarction, stroke, premature death, a variety of cancers, and other serious health outcomes. Possible explanations for this are prolonged exposure to elevated glucose levels, insulin resistance, endogenous hyperinsulinemia, and obesity. Observational studies have also suggested that exogenous insulin use may provoke these outcomes.

show abstract

“…Oral glukosetoleransetest er i noen studier vist å ha prognostisk verdi og kan vurderes etter en akutt koronar hendelse, men anbefales ikke som fast rutine (13,14,(16)(17)(18).…”

Section: Diskusjonunclassified

Prevalence of diabetes before and after first diagnosis of coronary artery disease

Jortveit¹,

Kaldal²,

Tonstad³

2018

Tidsskriftet

View full text Add to dashboard Cite

Forekomst av diabetes før og etter første gangs koronarsykdom | Tidsskrift for Den norske legeforening SERENA TONSTADSeksjon for preventiv kardiologi Avdeling for endokrinologi, sykelig overvekt og forebyggende medisin Oslo universitetssykehus Hun har bidratt med idé, utforming, tolkning av data, litteratursøk og utarbeiding/revisjon og har godkjent innsendte manusversjon. Serena Tonstad er overlege ved Avdeling for endokrinologi, sykelig overvekt og forebyggende medisin, ved OUS. Forfatter har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Hun har mottatt honorar fra AstraZeneca, Boehringer-Ingelheim, Novo-Nordisk og MSD. BAKGRUNN

show abstract

Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c: a report from EUROASPIRE IV—a survey from the European Society of Cardiology

Abstract: In patients with established coronary artery disease, the OGTT identifies the largest number of patients with previously undiagnosed diabetes and should be the preferred test when assessing the glycaemic state of such patients.

Cited by 90 publications

References 44 publications

Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV

Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV

Cardiovascular and Other Outcomes Postintervention With Insulin Glargine and Omega-3 Fatty Acids (ORIGINALE)

Prevalence of diabetes before and after first diagnosis of coronary artery disease

Contact Info

Product

Resources

About