Diagnostic value of markers of carbohydrate metabolism disorders in patients with coronary artery disease before planned percutaneous coronary intervention HTML

Authors: Yu.S. Ignatova1, V.N. Karetnikova1,2, A.M. Kochergina1,2, O.V. Gruzdeva2, A.A. Khorlampenko2, N.I. Zagorodnikov1, A.A. Kuz'mina2, O.L. Barbarash1,2

Company: 1Kemerovo State Medical University of Ministry of Health of the Russian Federation, ulitsa Voroshilova, 22a, Kemerovo, 650029, Russian Federation;
2Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovyy bul’var, 6, Kemerovo, 650002, Russian Federation

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Heading: Original articles

UDC: 616.12-005.4-07:616.132.2-089
DOI: https://doi.org/10.24022/1997-3187-2018-12-3-211-224

For citation: Ignatova Yu.S., Karetnikova V.N., Kochergina A.M., Gruzdeva O.V., Khorlampenko A.A., Zagorodnikov N.I., Kuz'mina A.A., Barbarash O.L. Diagnostic value of markers of carbohydrate metabolism disorders in patients with coronary artery disease before planned percutaneous coronary intervention. Creative Cardiology. 2018; 12 (3): 211–24 (in Russ.). DOI: 10.24022/1997-3187-2018-12-3-211-224

Received / Accepted:  09.02.2018/09.04.2018

Key Words: carbohydrate metabolism disorders markers coronary artery disease percutaneous coronary intervention

Abstract

Objective. To determine the diagnostic significance of carbohydrate metabolism disorders (CMD) markers in patients with coronary artery disease (CAD) and indications for percutaneous coronary intervention (PCI).

Material and methods. A prospective study was conducted during the period from August 2017 to November 2017 among patients admitted to the planned PCI in Research Institute for Complex Issues of Cardiovascular Diseases. Diagnosis of CMD was based on the diagnostic level of blood glucose, glycated hemoglobin (HbA1c), and postprandial blood glucose. Concentrations of fructosamine and 1.5-anhydroglucitol (1.5-AG) were studied as additional markers of CMD.

Results. Of the 140 patients, 54 (38.6%) were diagnosed for the first time with different types of CMD by the level fasting glucose, HbA1c and postprandial blood glucose: 15.7% had diabetes, 9.3% had impaired glucose tolerance (IGT), 13.6% – impaired fasting glycemia (IFG). Based on the results of the ROC analysis, the diagnostic value of fasting glucose in diabetes and IFG was proved (р <0.001). In the case of postprandial blood glucose, there was no reliable diagnostic value for all CMD. HbA1c more than 6.3% had a 72.1% sensitivity with diabetes (AUC 0.908; 95% CI 0.846–0.952; р <0.001), and HbA1c more than 5.3% for IFG (AUC 0.714; 95% CI 0.595–0.814; р=0,00). The concentration level of fructosamine more than 305 μmol / l was associated with the presence of diabetes (AUC 0.793; 95% CI 0.716–0.857; р <0.001). The sensitivity and specificity of 1.5-AG was unreliable for all CMD.

Conclusions. In patients with CHD and indications for PCI, the diagnostic value of fasting glucose and HbA1c for
diabetes and IFG and fructosamine for diabetes were demonstrated. Postprandial blood glucose and 1.5-AG did
not show any diagnostic value in any variant of CMD.

References

  1. Дедов И.И., Шестакова М.В., Майоров А.Ю., Викулова О.К., Галстян Г.Р., Кураева Т.Л. и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. 8-й выпуск. Сахарный диабет. 2017; 20 (1S): 1–121. DOI: 10.14341/DM20171S8.
  2. Бритов А.Н., Поздняков Ю.М., Волкова Э.Г., Драпкина О.М., Еганян Р.А., Кисляк О.М. и др. Национальные рекомендации по кардиоваскулярной профилактике. Кардиоваскулярная терапия и профилактика. 2011; 10 (6 S2): 2–64.
  3. Дедов И.И., Шестакова М.В., Викулова О.К. Эпидемиология сахарного диабета в Российской Федерации: клинико-статистический отчет по данным Федерального регистра сахарного диабета. Сахарный диабет. 2017; 20 (1): 13–41. DOI: 10.14341/DM8664.
  4. Тепляков А.Т., Гракова Е.В., Сваровская А.В., Копьева К.В., Лавров А.Г. Эффективность эндоваскулярной коронарной реваскуляризации у больных ИБС со сниженной фракцией выброса левого желудочка, ассоциированной с сахарным диабетом 2 типа: результаты пятилетного проспективного наблюдения. Комплексные проблемы сердечно-сосудистых заболеваний. 2017; VI (1): 79–91. DOI: 10.17802/2306-1278-2017-1.
  5. Billinger M., Räber L., Hitz S., Stefanini G.G., Pilgrim T., Stettler C. et al. Long-term clinical and angiographic outcomes of diabetic patients after revascularization with early generation drug-eluting stents. Am. Heart J. 2012; 163 (5): 876–86.e2. DOI: 10.1016/j.ahj.2012.02.014.
  6. Khaw K.T., Wareham N. Glycated hemoglobin as a marker of cardiovascular risk. Curr. Opin. Lipidol. 2006; 17: 637–43. DOI: 10.1097/MOL.0b013e3280106b95.
  7. Elley C.R., Kenealy T., Robinson E., Drury P.L. Glycated haemoglobin and cardiovascular outcomes in people with Type 2 diabetes: a large prospective cohort study. Diabet Med. 2008; 25 (11): 1295–301. DOI: 10.1111/j.1464-5491.2008.02581.x.
  8. Ma J., Wang X., Wang Y., Zhao Y., Gao M., Li X. The relationship between glycated hemoglobin and complexity of coronary artery lesions among older patients with diabetes mellitus. PLoS One. 2014; 9: e91972. DOI: 10.1371/journal.pone.0091972.
  9. Sorkin J.D., Muller D.C., Fleg J.L., Andres R. The relation of fasting and 2-h postchallenge plasma glucose concentrations to mortality: data from the Baltimore Longitudinal Study of Aging with a critical review of the literature. Diabetes Care. 2005; 28 (11): 2626–32. DOI: 10.2337/ diacare.28.11.2626.
  10. Cavalot F., Pagliarino A., Valle M., Di Martino L., Bonomo K., Massucco P. et al. Postprandial blood glucose predicts cardiovascular events and allcause mortality in type 2 diabetes in a 14-year follow- up: lessons from the San Luigi Gonzaga Diabetes Study. Diabetes Care. 2011; 34 (10): 2237–43. DOI: 10.2337/dc10-2414.
  11. Juraschek S.P., Steffes M.W., Selvin E. Associations of alternative markers of glycemia with hemoglobin A1c and fasting glucose. Clin. Chem. 2012; 58 (12): 1648–55. DOI: 10.1373/ clinchem.2012.188367.
  12. Selvin E., Rawlings A.M., Grams M., Klein R., Sharrett A.R., Steffes M. et al. Fructosamine and glycated albumin for risk stratification and prediction of incident diabetes and microvascular complications: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Lancet Diabetes Endocrinol. 2014; 2 (4): 279–88. DOI: 10.1016/S2213-8587(13)70199-2.
  13. Selvin E., Rawlings A., Lutsey P., Maruthur N., Pankow J.S., Steffes M. et al. Association of 1,5- anhydroglucitol with cardiovascular disease and mortality. Diabetes. 2016; 65 (1): 201–8. DOI: 10.2337/db15-0607.
  14. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. New York, NY: Nature Publ. Group; 2013.
  15. American Diabetes Association. Standards of medical care in diabetes – 2014. Diabetes Care. 2014; 37 (suppl. 1): S14–S80.
  16. Mitka M. Hemoglobin A1c poised to become preferred test for diagnosing diabetes. JAMA. 2009; 301 (15): 1528. DOI: 10.1001/jama.2009.479.
  17. Pfister R., Sharp S.J., Luben R., Khaw K.T., Wareham N.J. No evidence of an increased mortality risk associated with low levels of glycated haemoglobin in a non-diabetic UK population. Diabetologia. 2011; 54 (8): 2025–32. DOI: 10.1007/s00125-011-2162-0.
  18. James C., Bullard K.M., Rolka D.B., Geiss L.S., Williams D.E., Cowie C.C. et al. Implications of alternative definitions of prediabetes for prevalence in U.S. adults. Diabetes Care. 2011; 34 (2): 387–91. DOI: 10.2337/dc10-1314.
  19. Guo F., Moellering D.R., Garvey W.T. Use of HbA1c for diagnoses of diabetes and prediabetes: comparison with diagnoses based on fasting and 2-hr glucose values and effects of gender, race, and age. Metab. Syndr. Relat. Disord. 2014; 12 (5): 258–68. DOI: 10.1089/met.2013.0128.
  20. Zhou X., Pang Z., Gao W., Wang S., Zhang L., Ning F. et al. Performance of an A1C and fasting capillary blood glucose test for screening newly diagnosed diabetes and pre-diabetes defined by an oral glucose tolerance test in Qingdao, China. Diabetes Care. 2010; 33: 545–50. DOI: 10.2337/dc09-1410.
  21. Olson D.E., Rhee M.K., Herrick K., Ziemer D.C., Twombly J.G., Phillips L.S. Screening for diabetes and pre-diabetes with proposed A1C-based diagnostic criteria. Diabetes Care. 2010; 33 (10): 2184–9. DOI: 10.2337/dc10-0433.
  22. Tominaga M., Eguchi H., Manaka H., Igarashi K., Kato T., Sekikawa A. Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care. 1999; 22 (6): 920–4. DOI: 10.2337/diacare.22.6.920.
  23. Yamanouchi T., Inoue T., Ogata E., Kashiwabara A., Ogata N., Sekino N. et al. Post-load glucose measurements in oral glucose tolerance tests correlate well with 1,5-anhydroglucitol, an indicator of overall glycaemic state, in subjects with impaired glucose tolerance. Clin. Sci. (Lond). 2001; 101 (3): 227–33. DOI: 10.1042/cs1010227.
  24. Ouchi S., Shimada K., Miyazaki T., Takahashi S., Sugita Y., Shimizu M. et al. Low 1,5-anhydroglucitol levels are associated with long-term cardiac mortality in acute coronary syndrome patients with hemoglobin A1c levels less than 7.0. Cardiovasc. Diabetol. 2017; 16 (1): 151. DOI: 10.1186/s12933-017-0636-1.
  25. De la Hera J.M., Delgado E., Hernández E., García-Ruiz J.M., Vegas J.M., Avanzas P. et al. Prevalence and outcome of newly detected diabetes in patients who undergo percutaneous coronary intervention. Eur. Heart J. 2009; 30 (21): 2614–21. DOI: 10.1093/eurheartj/ehp278.

About Authors

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery