HbA1c Screening for Diabetes in Patients with Acute Coronary Syndrome: A Worthwhile Test or a Pitfall?
Robert Józwa1, Marta Bryśkiewicz2, Krzysztof Safranow3
1Department of Cardiology and Invasive Cardiology, Provincial Hospital, ul. Arkońska 4, 71-455 Szczecin, Poland.
Insights
Hemoglobin A1c (HbA1c) testing may underdiagnose diabetes in acute coronary syndrome (ACS) patients. Oral glucose tolerance tests (OGTT) are more effective for identifying glucose abnormalities in this population.
Area of Science:
- Endocrinology
- Cardiology
- Clinical Diagnostics
Background:
- Diagnostic concordance between HbA1c and glucose-based tests is imperfect.
- Data on glucose abnormalities in acute coronary syndrome (ACS) patients are lacking.
Purpose of the Study:
- Identify undiagnosed glucose abnormalities in ACS patients.
- Compare HbA1c screening effectiveness and consistency against oral glucose tolerance tests (OGTT).
Main Methods:
- 121 ACS patients without known glucose abnormalities were studied.
- HbA1c, admission, and fasting plasma glucose were assessed.
- OGTT was performed two weeks post-discharge for comparison.
Main Results:
- OGTT identified normoglycemia (45%), pre-diabetes (39.4%), and diabetes (15.6%).
- HbA1c identified normoglycemia (39.7%), pre-diabetes (51.2%), and diabetes (9.1%).
- HbA1c sensitivity for diabetes was 41% with 98% specificity (cut-off ≥6.5%); optimal cut-off was 5.9%.
Conclusions:
- HbA1c screening alone may significantly underdiagnose diabetes in ACS patients.
- Early but stable phase HbA1c testing without OGTT can lead to missed diagnoses.
Background:
Diagnostic concordance between HbA1c and other glucose-based tests is imperfect, and data on this problem in acute coronary syndrome (ACS) are still lacking. The aim of this study was to identify undiagnosed glucose abnormalities in ACS patients, and to compare the effectiveness and consistency of the diagnostic screening based on HbA1c to the oral glucose tolerance test (OGTT).
Methods:
The study group consisted of 121 ACS patients, mean age 62.3 ± 11.6 years, without known glucose abnormalities. HbA1c, admission and fasting plasma glucose in the first days of hospitalization were assessed and referred to the results of OGTT performed two weeks after discharge.
Results:
OGTT identified normoglycemia in 45%, pre-diabetes in 39.4%, and diabetes in 15.6%, while HbA1c revealed these categories in 39.7%, 51.2%, and 9.1%, respectively. With an HbA1c cut-off ≥6.5% (48 mmol/mol) diagnostic for diabetes, the sensitivity of the method was 41%, while specificity was 98%, compared to the OGTT. The optimal HbA1c cut-off value at the crossing of sensitivity and specificity curves was 5.9%. The HbA1c value recommended for the diagnosis of pre-diabetes and optimal cut-off point were the same (5.7%).
Conclusions:
Using HbA1c without OGTT in an early but stable phase of ACS may result in a significant underdiagnosis of diabetes.
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