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Diabetes often undiagnosed, untreated in heart disease patients
  NEW YORK (Reuters Health) - Diabetes often goes unrecognized and therefore uncontrolled in patients with acute coronary syndrome (ACS), according to research reported in the August 1st issue of the American Journal of Cardiology.
Lead author Dr. Darcy Green Conaway told Reuters Health "the majority of patients who present with an ACS have impaired glucose metabolism, and this represents an opportunity for physicians to dramatically alter a patient's course. Only once we recognize what we are missing can we then improve it."
In a cohort of 1,199 ACS patients who were seen at one of two hospitals in Kansas City, Missouri, 57% had abnormal glucose metabolism, Dr. Conaway and colleagues found. Of these, 321 (27%) had known diabetes mellitus and were excluded from further analysis.
Of the remaining 878 patients, 126 (14%) met criteria for new-onset diabetes, having a fasting plasma glucose level of 126 mg/dL or greater. However, only 35% of these patients (n = 44) were actually given a diagnosis and treated for their diabetes. "The remaining 65% (n=82) were left undiagnosed and, hence, untreated on discharge," the team notes.
"Importantly, we found a substantial number of patients who had high fasting plasma glucose levels (252 of 878; 29%), thus qualifying them for a diagnosis of impaired fasting glucose," the researchers write. "None of these patients received such a diagnosis."
"Because diabetes mellitus is considered by many to be a coronary atherosclerotic equivalent, it follows that one way to 'catch' some of these undiagnosed patients is to screen patients who present with an ACS with a simple fasting plasma glucose test," Dr. Conaway and colleagues note in their report.
Am J Cardiol 2005;96:363-365
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