Key result
HbA1c screening in patients admitted with acute coronary syndrome without known diabetes detected new-onset diabetes in 10.8% and pre-diabetes in 14.3% of patients.
Why the study?
Does HbA1c screening detect new onset diabetes in patients presenting with acute coronary syndrome without known diabetes?
Observational (n=399)
No
Does HbA1c screening detect new onset diabetes in patients presenting with acute coronary syndrome without known diabetes?
A simple HbA1c screening protocol in the acute post-ACS setting is practical and identifies new-onset diabetes or pre-diabetes in approximately 25% of patients without a prior diagnosis.
Answers are grounded in this paper and cite their sources.
HbA1c screening may detect new diabetes in ACS patients; leaves open whether it improves outcomes or warrants routine use.
Diabetes and pre-diabetes are prevalent in acute coronary syndrome (ACS) and relate to adverse outcomes. This study used HbA1c to screen for degrees of glucose intolerance amongst patients without known diabetes presenting with ACS. Over a 1-year period (June 2014–2015) consecutive patients admitted to a single centre cardiology unit with an initial diagnosis of ACS without prior diabetes diagnosis were electronically referred to our diabetes team. Patients were screened for the presence of diabetes by use of an initial HbA1c blood test on day 2 or 3 post admission. If abnormal (≥42 mmol/mol; ≥6.0%), patients were invited for a repeat HbA1c at 2 weeks, and if an intermediate result (42–47 mmol/mol; 6.0–6.4%), for an oral glucose tolerance test (OGTT) at 3 months. Patients were diagnosed with Type 2 diabetes if the repeat HbA1c result was high (≥48 mmol/mol; ≥6.5%) or the OGTT at 3 months confirmed the diagnosis. Other data collected included baseline demographics, risk factors and any history of cardiovascular disease. All patients with ACS were stratified according to the diagnosis and subsequent management. We screened 399 patients in total. The mean age was 65 ± 14 years, 268 (67%) were men, 290 (73%) were Caucasian, 95 (24%) were South Asian and 14 (4%) were Afro-Caribbean ethnicity. Of all patients, 57 (14.3%) were diagnosed as pre-diabetes and 43 (10.8%) newly diagnosed diabetes. During the study 28 (7%) patients could not be classified; 6 (1.5%) patients died during the study and 22 (5.5%) patients were missing either initial or repeat HbA1c and were subsequently lost to follow up. Of the baseline variables assessed, there were significantly more patients of South Asian ethnicity in the diabetes group compared to the normal group (42 vs 20%; p = 0.003). There was no difference in detection rates in patients with more severe ACS requiring percutaneous or cardiac surgical intervention. The use of a simple HbA1c screening method in clinical practice can detect new onset diabetes in approximately 1 in 10 high-risk post ACS patients.
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Lugg et al. (2017) conducted an observational in Acute coronary syndrome (n=399). HbA1c screening was evaluated on Detection of new onset diabetes. HbA1c screening in patients admitted with acute coronary syndrome without known diabetes detected new-onset diabetes in 10.8% and pre-diabetes in 14.3% of patients.