Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm 171 76, Sweden Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
Fellow of the European Society of Cardiology, Les Templiers, 2035 Route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex 06903, France Department of Public Health, Ghent University, Ghent, Belgium.
Eur Heart J. 2015 May 14;36(19):1171-7. doi: 10.1093/eurheartj/ehv008. Epub 2015 Feb 9.
Three methods are used to identify dysglycaemia: fasting plasma glucose (FPG), 2-h post-load plasma glucose (2hPG) from the oral glucose tolerance test (OGTT), and glycated haemoglobin A1c (HbA1c). The aim was to describe the yield and concordance of FPG, HbA1c, and 2hPG alone, or in combination, to identify dysglycaemia in patients with coronary artery disease.
In EUROASPIRE IV, a cross-sectional survey of patients aged 18-80 years with coronary artery disease in 24 European countries, 4004 patients with no reported history of diabetes had FPG, 2hPG, and HbA1c measured. All participants were divided into different glycaemic categories according to the ADA and WHO criteria for dysglycaemia. Using all screening tests together, 1158 (29%) had undetected diabetes. Out of them, the proportion identified by FPG was 75%, by 2hPG 40%, by HbA1c 17%, by FPG + HbA1c 81%, and by OGTT (=FPG + 2hPG) 96%. Only 7% were detected by all three methods FPG, 2hPG, and HbA1c. The ADA criteria (FPG + HbA1c) identified 90% of the population as having dysglycaemia compared with 73% with the WHO criteria (OGTT = FPG + 2hPG). Screening according to the ADA criteria for FPG + HbA1c identified 2643 (66%) as having a 'high risk for diabetes', while the WHO criteria for FPG + 2hPG identified 1829 patients (46%).
In patients with established coronary artery disease, the OGTT identifies the largest number of patients with previously undiagnosed diabetes and should be the preferred test when assessing the glycaemic state of such patients.
有三种方法可用于诊断糖代谢异常：空腹血糖（FPG）、口服葡萄糖耐量试验（OGTT）后 2 小时血糖（2hPG）和糖化血红蛋白 A1c（HbA1c）。本研究旨在描述 FPG、HbA1c 和 2hPG 单独或联合用于诊断冠心病患者糖代谢异常的检出率和一致性。
在 EUROASPIRE IV 研究中，对 24 个欧洲国家 18-80 岁的冠心病患者进行了一项横断面调查，共有 4004 例无糖尿病既往史的患者接受了 FPG、2hPG 和 HbA1c 检测。所有参与者均根据 ADA 和 WHO 糖代谢异常诊断标准分为不同的血糖类别。联合所有筛查试验，有 1158 例（29%）未检出糖尿病患者。其中，FPG 检出比例为 75%，2hPG 为 40%，HbA1c 为 17%，FPG+HbA1c 为 81%，OGTT（=FPG+2hPG）为 96%。仅 7%的患者同时符合 FPG、2hPG 和 HbA1c 三项标准。ADA 标准（FPG+HbA1c）诊断为糖代谢异常的患者占 90%，而 WHO 标准（OGTT=FPG+2hPG）诊断为 73%。根据 ADA 标准（FPG+HbA1c）进行筛查，有 2643 例（66%）患者被认为“有较高的糖尿病风险”，而 WHO 标准（FPG+2hPG）则有 1829 例（46%）患者被认为“有较高的糖尿病风险”。
在已确诊冠心病的患者中，OGTT 可检出最多数量的既往未诊断糖尿病患者，在评估此类患者的血糖状态时，应首选 OGTT 作为检查方法。
