https://doi.org/10.1177/2048872616669060 European Heart Journal: Acute Cardiovascular Care 2017, Vol. 6(8) 744–749 © The European Society of Cardiology 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872616669060 journals.sagepub.com/home/acc Background Type 2 diabetes mellitus (T2DM) is a serious metabolic derangement characterised by hyperglycaemia, insulin resistance and hyperinsulinaemia leading to micro- and macro-vascular complications, and it is a major risk factor for cardiovascular disease (CVD). 1 The prevalence of T2DM has been increasing in recent years. 2 Several studies have shown a high prevalence of undiag- nosed dysglycaemia in patients with acute coronary syndromes Editor’s Choice- Diagnosis of type 2 diabetes and prediabetes among patients with acute coronary syndromes Thorarinn A Bjarnason 1,2 , Linda B Kristinsdottir 2 , Erna S Oskarsdottir 2 , Steinar O Hafthorsson 2 , Isleifur Olafsson 3 , Sigrun H Lund 2 and Karl Andersen 1,2 Abstract Background: Previously undetected dysglycaemia is common among patients with acute coronary syndromes (ACSs). The aim of this study was to identify the most reliable method of diagnosing type 2 diabetes mellitus (T2DM) and prediabetes in ACS patients. Methods: Patients admitted to the coronary care unit with ACSs and no previous history of T2DM were consecutively included in the study. Glucose metabolism was measured by glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) with a standard oral glucose tolerance test during hospital admission, and this process was repeated 3 months later. In this study, the diagnosis of T2DM required at least two measurements above the diabetes cut-off point according to current American Diabetes Association and World Health Organization criteria. Results: A total of 250 patients were included in the study. T2DM was diagnosed in 7.2%. The sensitivities for detecting T2DM were 33.3%, 61.1% and 77.8% during admission and 27.8%, 61.1% and 72.2% at follow-up for HbA1c, FPG and 2hPG, respectively. The positive predictive values (PPVs) for diagnosing T2DM were 100%, 91.7% and 51.9% during admission and 71.4%, 91.7% and 65.0% at follow-up for HbA1c, FPG and 2hPG, respectively. The specificities and negative predictive values were high for all methods. By combining all measurements, the sensitivity was 100% and the PPV was 44.2%, while the combination of all HbA1c and FPG measurements provided 88.9% sensitivity and 80.0% PPV. Conclusion: Diagnosis of T2DM can be reliably carried out by repeated measurements of FPG and HbA1c in ACS patients, with limited added value of an oral glucose tolerance test. Keywords Type 2 diabetes, prediabetes, diagnosis, acute coronary syndrome, cardiovascular disease(s) Date received: 18 February 2016; accepted: 23 August 2016; final disposition set: 23 August 2016 1 Department of Medicine, Division of Cardiology, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland 2 University of Iceland, School of Health Sciences, Reykjavik, Iceland 3 Department of Clinical Biochemistry, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland Corresponding author: Karl Andersen, Department of Medicine, Division of Cardiology, Landspitali, The National University Hospital of Iceland, Reykjavík, IS-101, Iceland. Email: andersen@landspitali.is 669060ACC 0 0 10.1177/2048872616669060European Heart Journal: Acute Cardiovascular CareBjarnason et al. research-article 2016 Original scientific paper Downloaded from https://academic.oup.com/ehjacc/article/6/8/744/5921695 by guest on 07 November 2023