Oral glucose tolerance test in needed for appropriate classification of glucose regulation in patients with coronoary artery disease: a report from the euro heart survery on diabetes and the heart.

BACKGROUND Patients with coronary artery disease (CAD) and abnormal glucose regulation (AGR) are at high risk for subsequent cardiovascular events underlining the importance of accurate glucometabolic assessment in clinical practice. We investigated different methods to identify glucose disturbances among patients with acute and stable CAD. METHODS AND RESULTS Consecutive patients referred to cardiologists were prospectively enrolled at 110 centres in 25 countries (n= 4961). Fasting (FPG) and 2-h post 75-g glucose load glycaemia were requested in patients without known glucose abnormalities (n=3362). Glucose metabolism was classified according to WHO and ADA (1997, 2004) criteria as normal, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes. Fasting and 2-h post load glycaemia were available in 1867 patients, out of whom 870 (47%) had normal glucose regulation, 87 (5%) IFG, 519 (32%) IGT and 319 (17%) diabetes. If classification had been based on the ADA criterion from 1997 the proportion of misclassified (under-diagnosed) patients would have been 39%. Applying the ADA 2004 criterion would have over- diagnosed 8% and under-diagnosed 33% resulting in a total misclassification rate of 41%. By ethical concerns and practical reasons OGTT was not conducted in 1495 of eligible patients. These patients were more often females, had higher age and waist circumference and therefore if anything more likely to have abnormal glucose regulation than those who were included. A model based on easily available clinical and laboratory variables, including FPG, HDL-cholesterol, age and the logarithm of HbA1c, misclassified 44% of the patients, of which 18% were over- and 26 % under-diagnosed. CONCLUSION An oral glucose tolerance test is still the most appropriate method for the clinical assessment of glucometabolic status in patients with CAD

GUIDELINES ON DIABETES, PRE-DIABETES, AND CARDIOVASCULAR DISEASES

The Task Force on Diabetes and Cardiovascular diseases of the European Society of Cardiology and of the European Association for the Study of Diabetes.European Heart Journal (2007) 28, 88-136.</p

GUIDELINES ON DIABETES, PRE-DIABETES, AND CARDIOVASCULAR DISEASES

The Task Force on Diabetes and Cardiovascular diseases of the European Society of Cardiology and of the European Association for the Study of Diabetes.</p

GUIDELINES ON DIABETES, PRE-DIABETES, AND CARDIOVASCULAR DISEASES

The Task Force on Diabetes and Cardiovascular diseases of the European Society of Cardiology and of the European Association for the Study of Diabetes