Abstract
BackgroundThe 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.MethodsA 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.ResultsFifteen 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.ConclusionsDespite 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.
Highlights
Numerous studies have demonstrated that hyperglycemia is common among patients with acute coronary syndrome (ACS) [1,2], and the relationship between hyperglycemia and increased mortality risk in ACS has been well established across various glucose metrics [3,4]
A scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism does not encourage routine use of the oral glucose tolerance test (OGTT) for screening during the hospital stay [8]. This meta-analysis of prospective cohort studies to determine the accuracy of the OGTT in the diagnosis of diabetes in the acute phase of ACS compared to that in non-ACS cases was conducted to clarify this dispute with evidence
Characteristics and methodological quality of included studies Of the 5,521 references identified in the initial search, only 18 reports fulfilled the criteria for inclusion in the meta-analysis
Summary
Considering its accuracy and reproducibility in stress condition, the routine performance of an oral glucose tolerance test (OGTT) to diagnose diabetes during the statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism does not encourage routine use of the OGTT for screening during the hospital stay [8] This meta-analysis of prospective cohort studies to determine the accuracy of the OGTT in the diagnosis of diabetes in the acute phase of ACS compared to that in non-ACS cases was conducted to clarify this dispute with evidence. 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
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