Abstract 1182: High Frequency of Unrecognized Diabetes in Cardiovascular Patients: Should All Have an Oral Glucose Tolerance Test?
Introduction: Abnormal glucose metabolism is common in subjects at high risk of cardiovascular disease (CVD), and undiagnosed diabetes (DM) has been documented in >25% in cardiovascular population surveys.
Hypothesis: Among individuals ≥50 years old with known CVD, or ≥55 years old with cardiovascular risk factors (CVRF), models using data readily available in a clinic setting can predict those in whom an oral glucose tolerance test (OGTT) would diagnose DM.
Methods: Models were developed to identify undiagnosed DM among subjects screened for the Nateglinide and Valsartan in IGT Outcomes Research (NAVIGATOR) study. Random effects models used the basic variables age, gender, waist circumference, body mass index, systolic and diastolic blood pressures, and presence of CVD or CVRF. An enhanced model with laboratory variables added LDL cholesterol, triglycerides, and fasting glucose. We also examined classification by the metabolic syndrome.
Results: Of 41,432 NAVIGATOR screenees from 39 countries who had an OGTT, only 20.6% had normal glucose tolerance; 22.2% had undiagnosed DM, 28.8% had impaired glucose tolerance (IGT), and 28.4% had impaired fasting glucose (IFG). The AROC for the basic and enhanced models were 0.62 and 0.75 (Table 1⇓). Presence of the metabolic syndrome only achieved an AROC of 0.58.
Conclusions: Unrecognized DM was present in 22.2% of a global population at high CVD risk and models poorly predicted those with DM. Thus, an OGTT should be considered for all middle- and older-aged subjects with known CVD or CVRF to identify those with undiagnosed diabetes, allowing early intervention and intensive CVRF management.