Abstract
BACKGROUND: The diagnosis of diabetes mellitus (DM) is based on either fasting plasma glucose levels or an oral glucose tolerance test (OGTT). Recently, an HbA₁c value of ≥ 48 mmol/mol (6.5%) has been included as an additional test to diagnose DM. The purpose of this study was to validate HbA1c versus OGTT as a method to diagnose DM in vascular surgery patients. METHODS: The study population consisted of 345 patients admitted consecutively due to peripheral arterial disease. Sixty-seven patients were previously diagnosed with DM. Glucose levels of OGTT and HbA₁c values were analyzed in 275 patients. The OGTT results were categorized into three groups according to the World Health Organization 1999 criteria: 1) DM defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L and/or two-hour value (2-h-value) ≥ 11.1 mmol/L; 2) intermediate hyperglycaemia, which consists of IGT (FPG < 7.0 mmol/L and a 2-h-value between 7.8 mmol/L and 11.1 mmol/L), and IFG (fasting glucose value between 6.1 mmol/L and 7.0 mmol/L with a normal 2-h-value); and 3) normal glucose metabolism defined as FPG < 6.1 mmol/L and a 2-h-value < 7.8 mmol/L. RESULTS: Of the 275 patients on whom OGTT was performed, 33 were diagnosed with DM, 90 with intermediate hyperglycaemia and 152 had normal glucose metabolism. An HbA₁c value of ≥ 48 mmol/mol (6.5%) detected DM with a 45.5% sensitivity and a 90% specificity compared with the OGTT results. Combining the measurements of the HbA₁c value with the fasting plasma glucose level (≥7.0 mmol/L) increased the sensitivity to 64%. The total prevalence of DM and intermediate hyperglycaemia was 85% based on HbA1c values and 45% based on the OGTT. CONCLUSIONS: Compared with the OGTT the HbA₁c cut-off value of ≥ 48 mmol/mol (6.5%) had a 45.5% sensitivity to diagnose DM in patients with peripheral arterial disease. OGTT and HbA₁c categorized different individuals with DM and intermediate hyperglycaemia. The total prevalence of pathologic glucose metabolism was substantially higher based on HbA₁c values than based on OGTT. The high prevalence of DM and intermediate hyperglycaemia when using HbA₁c in this study may reflect a high chronic glycaemic burden in patients with peripheral arterial disease. Further studies on vascular surgery patients are needed to identify which method, OGTT or HbA₁c, is the better in predicting DM and future clinical development of vascular disease. TRIAL REGISTRATION: REK vest 14109.