Background:
Diabetes mellitus is one of the most important
risk factors of
coronary artery disease. Admission
hyperglycemia adversely influences the outcome of
acute coronary syndrome patients. The study was conducted to compare the various diagnostic
methods for the
detection of undiagnosed
diabetes mellitus in
acute coronary syndrome patients with admission hyperglycaemia in Bangladeshi
population.
Methods:
It was a cross sectional
comparative study involving 157
patients with admission
blood glucose level e”7.8 mmol/l.
Fasting plasma glucose, Glycated haemoglobin, pre-discharge
oral glucose tolerance test was measured in all subjects and comparison of performance of different
methods was done.
Results:
Oral glucose tolerance test revealed that in spite of admission hyperglycaemia, 57 (36.3%)
patients were diabetic and 52 (33.12%)
patients had impaired
glucose homeostasis and 48 (30.57%)
patients had normal
glucose metabolism. Undiagnosed diabetes could not be adequately predicted with admission
plasma glucose,
fasting plasma glucose or HbA1c alone (area under the
ROC curve 0.589, 0.825 and 0.852 respectively).
Conclusion:
Admission hyperglycaemia does not
diagnose diabetes reliably in a stressful condition like
acute coronary syndrome. Although neither admission
plasma glucose,
fasting plasma glucose, nor HbA1c level were as good as
oral glucose tolerance test in detecting true diabetes, but combined
fasting plasma glucose & HbA1c were found to be more sensitive & specific
screening tool for detecting unknown diabetes in
acute coronary syndrome patients with admission hyperglycaemia.