HbA1c for Diabetes Screening in Acute Coronary Syndrome: time for a reappraisal of the guidelines?
C McCune1, S Maynard1, B McClements1
1Department of Cardiology.
Insights
Screening for diabetes in acute coronary syndrome (ACS) patients using HbA1c is more effective than current guidelines. This approach identifies more cases of diabetes in ACS populations.
Area of Science:
- Cardiology
- Endocrinology
- Diabetes Mellitus
Background:
- Diabetes is common in patients with acute coronary syndrome (ACS).
- Current National Institute for Health and Care Excellence (NICE) guidelines recommend screening for diabetes using fasting plasma glucose (FPG) 4 days post-admission for hyperglycaemic patients.
- The World Health Organization (WHO) has approved HbA1c for diagnosing and screening type 2 diabetes.
Purpose of the Study:
- To evaluate the utility of HbA1c as a universal screening test for diabetes in ACS patients.
- To compare HbA1c screening with existing NICE guidelines for diabetes detection in this population.
Main Methods:
- A retrospective audit of the MINAP database identified patients meeting NICE criteria.
- A prospective service improvement project used HbA1c for universal diabetes screening in ACS patients over 4 months.
- Patients were categorized based on WHO criteria for diabetes.
Main Results:
- The audit found 22% of ACS patients had pre-existing diabetes and 2.4% met NICE screening criteria.
- In the prospective project, only 4% met NICE criteria, but HbA1c testing on admission identified 65.4% of tested patients as having probable diabetes or high risk.
- HbA1c screening identified a higher proportion of diabetes cases compared to NICE criteria.
Conclusions:
- A substantial number of ACS patients have undiagnosed diabetes.
- Universal HbA1c testing is a practical and efficient method for screening diabetes in the ACS population.
- HbA1c testing may improve early detection and management of diabetes in ACS patients.
Objective:
Diabetes is highly prevalent in individuals with acute coronary syndrome (ACS). Current NICE guidelines recommend diabetes screening of hyperglycaemic patients using a fasting plasma glucose after 4 days from admission. In 2012 the World Health Organisation (WHO) approved the use of HbA1c in the diagnosis and targeted screening for type 2 diabetes. We introduced a service improvement project using HbA1c for diabetes screening in patients with no previous diagnosis of diabetes admitted with ACS regardless of glycaemic state.
Method:
An initial retrospective audit utilised 21 months of data from the MINAP database to identify patients meeting current NICE criteria for diabetes screening. A prospective service improvement project was undertaken over a 4 month period using HbA1c as a universal screening test to categorise ACS patients based on WHO criteria.
Results:
The retrospective audit identified 93 of 420 (22%) patients with pre-existing diabetes and 8 of the remaining 327 (2.4%) were hyperglycaemic, thus meeting NICE criteria for diabetes screening. In the service improvement project 2/49 patients (4%) met NICE criteria for diabetes screening. Twenty six of these 49 patients had a HbA1c test on admission and 17/26 (65.4%) were classified as probable diabetes or high risk.
Conclusion:
A significant proportion of ACS patients have diabetes, which may be undetected by current NICE criteria. Universal HbA1c testing offers utility as a simple and effective screening test for diabetes in the ACS population.
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