Article

Diabetes and pre-diabetes are highly prevalent in patients with a
history of acute coronary syndrome. This is why screening for glucose metabolism
disorders is recommended in patients following an acute coronary syndrome. The
aim of our study was to determine whether glycated haemoglobin alone compared
with the oral glucose tolerance test could allow effective screening for glucose
metabolism disorders in acute coronary syndrome patients undergoing cardiac
rehabilitation. Patients and methods Among 347 patients with a recent history of
acute coronary syndrome enrolled in our cardiac rehabilitation centre, 267
patients without previously known diabetes were recruited for this prospective
study with performance of both oral glucose tolerance test and glycated
haemoglobin measurement.
The patients were divided into three groups: newly
diagnosed diabetes mellitus, pre-diabetes and normoglycaemia according to the
oral glucose tolerance test and glycated haemoglobin results. The results
obtained with glycated haemoglobin were compared with those obtained with the
oral glucose tolerance test, considered as the reference. Results For the
diagnosis of diabetes, glycated haemoglobin had a sensitivity of 72% and a
specificity of 100%. Positive and negative predictive values were high at 100%
and 96%, respectively. However, for the diagnosis of pre-diabetes the sensitivity
of glycated haemoglobin was low at 64% as were the specificity (53%) and the
positive predictive values (37%). Glycated haemoglobin overdiagnosed pre-diabetes
(52% vs 30%, p < 0.0001). For the diagnosis of normoglycaemia, the sensitivity of
glycated haemoglobin was also low (48%). Conclusion
According to our study,
glycated haemoglobin has low sensitivity and specificity for the detection of
pre-diabetes in patients with coronary disease enrolled in cardiac
rehabilitation, and glycated haemoglobin over-diagnoses pre-diabetes in
comparison with the oral glucose tolerance test.

Langue : ANGLAIS