Clinical Research in Cardiology

, Volume 101, Issue 8, pp 625–630 | Cite as

Comparison of HbA1c and oral glucose tolerance test for diagnosis of diabetes in patients with coronary artery disease

  • Serdar FarhanEmail author
  • Rudolf Jarai
  • Ioannis Tentzeris
  • Alexandra Kautzky-Willer
  • Eslam Samaha
  • Peter Smetana
  • Gabriele Jakl-Kotauschek
  • Johann Wojta
  • Kurt Huber
Original Paper



Measurement of glycated hemoglobin A1c (HbA1c) to diagnose diabetes mellitus (DM-2) is recommended by several expert groups. DM-2 occurs very frequently among patients with coronary artery disease (CAD). Therefore, we aimed to investigate the diagnostic strengths of HbA1c and oral glucose tolerance test (OGTT) in detecting latent glucometabolic disturbances among patients with CAD.

Materials and methods

One hundred ninety-nine consecutive patients admitted with CAD were included in this observational study. Fasting plasma glucose as well as HbA1c measurement was performed in all study participants and those without preexisting DM-2 underwent an OGTT.


Patients were subdivided according to their medical history into those with previous DM-2 (n = 37). The remaining 162 patients underwent OGTT, which revealed 39 patients with diabetes (DM-OGTT), 35 with impaired glucose tolerance (IGT), 20 with impaired fasting glucose (IFG) and 68 with normal glucose tolerance (NGT). Using HbA1c resulted in 6.8% DM and 45.6% at risk (HbA1c 5.7–6.4%) diagnosis. OGTT identified 24.1% DM (p = 0.002 compared with HbA1c) and 21.6% IGT patients. Among those with intermediate HbA1c (5.7–6.4%) 26.5% patients were NGT and only 30.9% displayed DM-2 by use of OGTT. Among patients with HbA1c of <5.7%, 44% (n = 31) of patients had disturbed glucose metabolism. Using receiver-operating curve HbA1c cutoff with the highest sensitivity and specificity was found to be 5.8%.


There is a large discordance between OGTT and HbA1c in terms of detecting latent DM-2 in patients with CAD. Measurement of HbA1c could result in lower propensity of DM-2 diagnosis.


Diabetes mellitus Coronary artery disease Oral glucose tolerance test Glycated hemoglobin 



This work was supported by the Association for the Promotion of Scientific Research in Arteriosclerosis, Thrombosis and Vascular Biology (ATVB).

Conflict of interest

There are neither financial nor non-financial disclosures for all authors to declare.


  1. 1.
    Kannel WB, McGee DL (1979) Diabetes and cardiovascular disease. The Framingham study. JAMA 241:2035–2038PubMedCrossRefGoogle Scholar
  2. 2.
    Dziewierz A, Giszterowicz D, Siudak Z, Rakowski T, Dubiel JS, Dudek D (2010) Admission glucose level and in-hospital outcomes in diabetic and non-diabetic patients with acute myocardial infarction. Clin Res Cardiol 99:715–721PubMedCrossRefGoogle Scholar
  3. 3.
    Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234PubMedCrossRefGoogle Scholar
  4. 4.
    Bartnik M, Ryden L, Ferrari R, Malmberg K, Pyorala K, Simoons M, Standl E, Soler–Soler J, Ohrvik J (2004) The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 25:1880–1890PubMedCrossRefGoogle Scholar
  5. 5.
    Hu DY, Pan CY, Yu JM (2006) The relationship between coronary artery disease and abnormal glucose regulation in China: The China Heart Survey. Eur Heart J 27:2573–2579PubMedCrossRefGoogle Scholar
  6. 6.
    Wascher TC, Sourij H, Roth M, Dittrich P (2004) Prevalence of pathological glucose metabolism in patients undergoing elective coronary angiography. Atherosclerosis 176:419–421PubMedCrossRefGoogle Scholar
  7. 7.
    American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(Suppl 1):S62–S69CrossRefGoogle Scholar
  8. 8.
    International Expert Committee (2009) International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 32:1327–1334CrossRefGoogle Scholar
  9. 9.
    World Health Organization and International Diabetes Federation (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. World Health Organization, GenevaGoogle Scholar
  10. 10.
    Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetes Med 15:539–553CrossRefGoogle Scholar
  11. 11.
    Olson DE, Rhee MK, Herrick K, Ziemer DC, Twombly JG, Phillips LS (2010) Screening for diabetes and prediabetes with proposed A1c-based diagnostic criteria. Diabetes Care 33:2184–2189PubMedCrossRefGoogle Scholar
  12. 12.
    Lorenzo C, Wagenknecht LE, Hanley AJ, Rewers MJ, Karter AJ, Haffner SM (2010) Hemoglobin A1c between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: the insulin resistance atherosclerosis study (IRAS). Diabetes Care 33:2104–2109PubMedCrossRefGoogle Scholar
  13. 13.
    Kramer CK, Araneta MR, Barrett-Connor E (2010) A1C and diabetes diagnosis: the Rancho Bernardo study. Diabetes Care 33:101–103PubMedCrossRefGoogle Scholar
  14. 14.
    Buell C, Kermah D, Davidson MB (2007) Utility of A1C for diabetes screening in the 1999 2004 NHANES population. Diabetes Care 30:2233–2235PubMedCrossRefGoogle Scholar
  15. 15.
    van’t Riet E, Alssema M, Rijkelijkhuizen JM, Kostense PJ, Nijpels G, Dekker JM (2010) Relationship between A1C and glucose levels in the general Dutch population: the new Hoorn study. Diabetes Care 33:61–66CrossRefGoogle Scholar
  16. 16.
    Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516PubMedCrossRefGoogle Scholar
  17. 17.
    Tekumit H, Cenal AR, Polat A, Uzun K, Tataroglu C, Akinci E (2010) Diagnostic value of hemoglobin A1c and fasting plasma glucose levels in coronary artery bypass grafting patients with undiagnosed diabetes mellitus. Ann Thorac Surg 89:1482–1487PubMedCrossRefGoogle Scholar
  18. 18.
    Bao Y, Ma X, Li H, Zhou M, Hu C, Wu H, Tang J, Hou X, Xiang K, Jia W (2010) Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey. BMJ 340:c2249PubMedCrossRefGoogle Scholar
  19. 19.
    Boavida JM, Gardete-Correia L, Massano-Cardoso S, Mesquita C, Raposo JF (2010) Hemoglobin A1c in a population with pre-diabetes, diagnosed and previously undiagnosed diabetes. Diabetologia 53:S87Google Scholar
  20. 20.
    Cosson E, Nguyen M, Hamo Tchatchouang E, Banu I, Chiheb S, Valensi P (2010) Diagnosis of abnormal glucose levels in patients at high risk for the development of diabetes: a comparison of the oral glucose tolerance test and measurement of HbA1c following the American Diabetes Association recommendations 2010. Diabetologia 53:S87Google Scholar
  21. 21.
    Delgado E, De la Hera JM, Lozano I, Hernandez E, Vegas JM, Fernandez-Cimadevilla C, Torres F, Carro A, Bayon J, Garcia-Ruiz JM, Avanzas P (2010) Detection of diabetes in coronary artery disease: oral glucose tolerance test or glycated haemoglobin and fasting plasma glucose? Diabetologia 53:S159Google Scholar
  22. 22.
    Koehler C, Henkel E, Schaper F, Hanefeld M (2010) The HbA1c cut points for detecting type 2 diabetes and prediabetes in a risk population—is this the right way? Diabetologia 53:S158Google Scholar
  23. 23.
    Sourij H, Saely CH, Schmid F, Zweiker R, Marte T, Wascher TC, Drexel H (2010) Post-challenge hyperglycaemia is strongly associated with future macrovascular events and total mortality in angiographied coronary patients. Eur Heart J 31(13):1583–1590PubMedCrossRefGoogle Scholar
  24. 24.
    Unwin N, Shaw J, Zimmet P, Alberti KG (2002) Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabetes Med 19:708–723CrossRefGoogle Scholar
  25. 25.
    Preiss D, Welsh P, Murray HM, Shepherd J, Packard C, Macfarlane P, Cobbe S, Ford I, Sattar N (2010) Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up. Eur Heart J 31:1230–1236PubMedCrossRefGoogle Scholar
  26. 26.
    Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, Cosentino F, Jonsson B, Laakso M, Malmberg K, Priori S, Ostergren J, Tuomilehto J, Thrainsdottir I, Vanhorebeek I, Stramba-Badiale M, Lindgren P, Qiao Q, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL, Deckers JW, Bertrand M, Charbonnel B, Erdmann E, Ferrannini E, Flyvbjerg A, Gohlke H, Juanatey JR, Graham I, Monteiro PF, Parhofer K, Pyorala K, Raz I, Schernthaner G, Volpe M, Wood D (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The task force on diabetes and cardiovascular diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 28:88–136PubMedCrossRefGoogle Scholar
  27. 27.
    Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 359:2072–2077PubMedCrossRefGoogle Scholar
  28. 28.
    Knudsen EC, Seljeflot I, Abdelnoor M, Eritsland J, Mangschau A, Arnesen H, Andersen GO (2009) Abnormal glucose regulation in patients with acute ST-elevation myocardial infarction—a cohort study on 224 patients. Cardiovasc Diabetol 8:6PubMedCrossRefGoogle Scholar
  29. 29.
    Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendic S, Ryden L, Malmberg K (2002) Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 359:2140–2144PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Serdar Farhan
    • 1
    Email author
  • Rudolf Jarai
    • 1
  • Ioannis Tentzeris
    • 1
  • Alexandra Kautzky-Willer
    • 2
  • Eslam Samaha
    • 3
  • Peter Smetana
    • 1
  • Gabriele Jakl-Kotauschek
    • 1
  • Johann Wojta
    • 3
  • Kurt Huber
    • 1
  1. 1.Third Department of Medicine, Cardiology an Emergency MedicineWilhelminen HospitalViennaAustria
  2. 2.Third Department of Endocrinology and MetabolismUniversity of MedicineViennaAustria
  3. 3.Second Department of CardiologyUniversity of MedicineViennaAustria

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