Key result
Inpatient OGTT during ACS reliably detects diabetes, showing comparable sensitivity but slightly lower specificity than in non-ACS settings.
Why the study?
The appropriateness of routinely performing an oral glucose tolerance test to screen for diabetes mellitus during acute coronary syndrome hospitalization was still under debate.
Does performing a 75 g oral glucose tolerance test during acute coronary syndrome hospitalization accurately diagnose diabetes mellitus compared to testing in non-ACS individuals?
Meta-Analysis (n=8,027)
Does performing a 75 g oral glucose tolerance test during acute coronary syndrome hospitalization accurately diagnose diabetes mellitus compared to testing in non-ACS individuals?
Performing an oral glucose tolerance test during hospitalization for acute coronary syndrome provides diagnostic accuracy for diabetes mellitus comparable to that in non-ACS populations after accounting for age and retesting interval, supporting in-hospital screening.
Supports in-hospital OGTT for diabetes screening in ACS; confirms comparable diagnostic accuracy to non-ACS settings.
BACKGROUND: The appropriateness of the routine performance of an oral glucose tolerance test (OGTT) to screen for diabetes mellitus (DM) during acute coronary syndrome hospitalization is still under debate. METHODS: A systematic search of databases (MEDLINE [1985 to March 2012], EMBASE [1985 to March 2012]) was conducted. All prospective cohort studies assessing the accuracy or reproducibility of an OGTT in ACS or non-ACS individuals were included. A bivariate model was used to calculate the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Heterogeneity was explored using subgroup analysis and meta-regression. RESULTS: Fifteen studies with 8,027 participants were included (10 ACS and 5 non-ACS studies). The pooled results on SEN, SPE, PLR, NLR, and DOR were 0.70 (95% CI, 0.60-0.78), 0.91 (95% CI, 0.86-0.94), 7.6 (95% CI, 4.9-11.7), 0.33 (95% CI, 0.25-0.45), and 23 (95% CI, 12-41), respectively. The OGTT has a slightly lower SPE in diagnosing DM in ACS than in non-ACS patients (0.86 [95% CI 0.81-0.92] versus 0.95 [95% CI 0.93-0.98], p<0.01), while the SEN values are comparable (0.71 [95% CI 0.60-0.82] versus 0.67 [95% CI 0.54-0.81], p=0.43). After adjusting the interval between repeated tests and age, the meta-regression did not show a difference in DOR between ACS and non-ACS studies. CONCLUSIONS: Despite the discrepancy in the interval between the two OGTTs, performing an OGTT in patients with ACS provides accuracy that is similar to that in in non-ACS patients. It is reasonable to screen patients hospitalized for ACS for previously undiagnosed DM using an OGTT.
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Ye et al. (2012) conducted a meta-analysis in Diabetes mellitus screening during acute coronary syndrome hospitalization (n=8,027). Oral glucose tolerance test (OGTT) during acute coronary syndrome hospitalization vs. Follow-up repeated OGTT (reference standard) and non-ACS individuals was evaluated on Diagnostic accuracy (sensitivity, specificity, and diagnostic odds ratio) for diagnosing diabetes mellitus (OR 23, 95% CI 12-41). Oral glucose tolerance testing during ACS hospitalization demonstrated comparable sensitivity (0.71 vs 0.67, p=0.43) and slightly lower specificity (0.86 vs 0.95, p<0.01) for diagnosing diabetes compared with non-ACS patients.
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