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Original Articles: Adult Cardiac

Diagnostic Value of Hemoglobin A1c and Fasting Plasma Glucose Levels in Coronary Artery Bypass Grafting Patients With Undiagnosed Diabetes Mellitus

Hayrettin Tekumit, MD^a,_*, Ali Rza Cenal, MD^a, Adil Polat, MD^b, Kemal Uzun, MD^a, Cenk Tataroglu, MD^a, Esat Akinci, MD^a

^a Avrupa Safak Hastanesi, Istanbul, Turkey
^b John F. Kennedy Hospital, Istanbul, Turkey

Accepted for publication November 11, 2009.

^_* Address correspondence to Dr Tekümit, Ozel Avrupa Safak Hastanesi, Kucukkoy yolu Hamam sok. No. 2, Gaziosmanpasa, Istanbul, Turkey (Email: htekumit{at}yahoo.com).

Background: Early detection, diagnosis, and treatment of diabetes are of utmost importance in preventing diabetic complications and improving short- and long-term outcomes in patients undergoing coronary artery bypass grafting surgery. The aim of this study was to evaluate the ability of preoperative hemoglobin A1c (HbA_1c) measurement, either alone or in combination with fasting plasma glucose (FPG), to detect glycometabolic disturbances among patients undergoing elective on-pump coronary surgery.

Methods: A total of 166 patients who underwent elective isolated on-pump coronary surgery were included. Hemoglobin A1c and 8-hour FPG measurements were obtained by venous blood sampling on the day before the operation. After 1 month, an oral glucose tolerance test was performed in all discharged patients without known diabetes. The sensitivity and specificity for the diagnosis of diabetes were analyzed for FPG, HbA_1c, and for the combined use of HbA_1c and FPG, in reference to the tolerance test results.

Results: Sixty percent of patients without known diabetes were diagnosed as diabetes or prediabetes with glucose tolerance test. Compared with either test alone, combined use of FPG and HbA_1c had higher sensitivity and specificity. Positive predictive values for FPG, HbA_1c, and combined use of these two factors were 83.6%, 94%, and 97%, respectively. The combined use had a sensitivity and specificity of 84.4% and 94.1%, respectively.

Conclusions: Fasting plasma glucose alone does not seem sufficient for diagnosing approximately half of the patients with dysglycemia. Our results suggest that the use of FPG and HbA_1c measurements in combination may be a useful strategy to preoperatively identify coronary patients with unknown diabetes.

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