Comparison of diagnostic screening methods for diabetes in patients with heart failure

• Published in: Diabetes epidemiology and management Vol. 9; p. 100109
• Main Authors: Ishikawa, Yuta, Laing, Emma M., Anderson, Alex K., Zhang, Donglan, Kindler, Joseph M., Trivedi-Kapoor, Rupal, Sattler, Elisabeth L. P.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01-01-2023; Elsevier
• Subjects: Diabetes; Fasting plasma glucose; Heart failure; Hemoglobin A1c; National Health and Nutrition Examination Survey; Two-hour plasma glucose; Heart failure; Two-hour plasma glucose; Diabetes; Fasting plasma glucose; National Health and Nutrition Examination Survey; Hemoglobin A1c
• ISSN: 2666-9706; 2666-9706
• DOI: 10.1016/j.deman.2022.100109

The objective of the study was to compare screening performances of HbA1c, fasting plasma glucose (FPG), and two-hour plasma glucose (2hPG) in heart failure (HF) patients.
We included 237 HF patients aged >20 years without history of diabetes, using National Health and Nutrition Examination Survey data (2005–2016). American Diabetes Association diabetes screening criteria were used: (1) HbA1c ≥6.5%, (2) FPG ≥126 mg/dL, and (3) 2hPG ≥200 mg/dL. Sensitivity, specificity, predictive values, and Receiver Operating Characteristic (ROC) curves for HbA1c and FPG were examined against reference methods.
N = 50 patients (20.5%) met at least 1 of 3 clinical criteria for diabetes. 2hPG alone identified 70.5% of patients, whereas HbA1c alone identified only 27.0% of patients. Sensitivity and specificity using a HbA1c cutoff at ≥6.5% were 24.4% and 97.6%, respectively. The Youden's J statistic for HbA1c was maximized at 6.1%. The area under the ROC curve of HbA1c against 2hPG was significantly lower compared to FPG (0.79, 95% CI 0.70-0.88; 0.89, 95% CI 0.84-0.94, respectively; p = 0.04).
Blood glucose criteria are more sensitive than HbA1c when screening HF patients for diabetes. Future studies should test performance of a HbA1c cutoff at 6.1% when FPG or 2hPG cannot be completed.