oa Journal of Endocrinology, Metabolism and Diabetes in South Africa - Unsuspected glucose abnormalities in patients with coronary artery disease

Volume 11, Issue 1
  • ISSN : 1608-9677
  • E-ISSN: 2220-1009



&lt;I&gt;Objectives.&lt;/I&gt; To compare the ability of fasting glucose, glycosylated haemoglobin (HbA<sub>1c</sub>), the American Diabetic Association (ADA) score and measures of the metabolic syndrome (waist circumference, high-density lipoprotein (HDL), and triglycerides) in predicting an initial diagnosis of diabetes mellitus or abnormal glucose tolerance based on the World Health Organization (WHO) criteria. &lt;br&gt;&lt;I&gt;Design.&lt;/I&gt; A cross-sectional, diagnostic study was undertaken of 120 patients admitted to the cardiology wards of Pretoria Academic Hospital for elective coronary angiographic studies. <br><I>Main outcome measures.&lt;/I&gt; All subjects underwent a modified glucose tolerance test whereby fasting and 2-hour post glucose (75 g) plasma glucose levels were measured. Using the revised WHO criteria, the overall incidence of diabetes was found to be 11.7% (95% confidence interval (CI): 6.5 - 19) and the overall incidence of abnormal glucose tolerance was 46% (CI: 37 - 55). &lt;br&gt;&lt;I&gt;Results.&lt;/I&gt; In univariate analysis for the diagnosis of diabetes, HbA&lt;sub&gt;1c&lt;/sub&gt; (p < 0.05) yielded the largest area (0.76) under the receiver operating characteristic (ROC) curve, with a sensitivity of 21%, specificity of 99%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 91%. For the prediction of abnormal glucose tolerance, applying multivariate analysis using a logistic regression model, the combination of age, ethnic group, serum HDL, serum triglycerides and HbA&lt;sub&gt;1c&lt;/sub&gt; yielded an area under the ROC curve of 0.79, sensitivity of 66%, specificity of 80%, PPV of 76% and a NPV of 71%. &lt;br&gt;&lt;I&gt;Conclusion.&lt;/I&gt; Most subjects with diabetes mellitus (9 of 14) would not have been detected if a 2-hour oral glucose tolerance test had not been done. Addition of either HbA&lt;sub&gt;1c&lt;/sub&gt; or lipid parameters to the model of age and ethnic group were similar in predicting abnormal glucose tolerance.

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