Frequency of undiagnosed diabetes mellitus in patients with acute coronary syndrome
Open accessAbstract
In a prospective cohort of patients who had acute coronary syndrome, we used a simple fasting plasma glucose to identify previously unrecognized diabetes mellitus. A total of 57% of patients who had acute coronary syndrome had abnormal glucose metabolism; approximately 66% of those who met criteria for new diabetes were not diagnosed or treated as such by the physicians who managed them.
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- Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Of the 126 patients meeting criteria for new-onset diabetes mellitus, 44 (35%) were diagnosed with new-onset diabetes mellitus at discharge.
“As shown in Figure 3, only 44 of these patients (35%) were diagnosed as having new-onset DM on discharge.”
- Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
“Of 126 patients who presented with ACS and met the criteria for new DM with a high FPG level, 44 of 126 (35%) were recognized as having DM by physicians.”
Quote in the paperSubstantial claim - Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
- Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Of the 1,199 acute coronary syndrome patients, 321 (27%) had known diabetes mellitus on admission.
“Of these, 321 (27% of 1,199) were previously diagnosed with DM and thus were excluded from further analysis.”
- Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
“Among 1,199 patients who presented with ACS, 321 (27%) had known DM on admission.”
Quote in the paperSubstantial claim - Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
- Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Of the 126 patients meeting criteria for new-onset diabetes mellitus, 82 (65%) were not recognized as having diabetes mellitus by the treating team and remained undiagnosed at discharge.
“The remaining 82 patients (65%) who met criteria for a new diagnosis of DM were not recognized by the team that provided care for patients' ACS.”
- Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
“In the remaining 82 (65%), DM remained undiagnosed on hospital discharge.”
Quote in the paperSubstantial claim - Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
- Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Lack of previous angina was associated with recognition of diabetes mellitus (18.2% recognized vs 39.0% unrecognized, p = 0.017).
“and a lack of previous angina (18.2% for recognized vs 39.0% for unrecognized, p ϭ 0.017).”
Quote in the paperNot a substantial claim - Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Among 1,199 patients presenting with acute coronary syndrome, 57% (699) had abnormal glucose metabolism.
“A total of 57% of patients who had acute coronary syndrome had abnormal glucose metabolism”
- Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
“Among the 1,199 patients who had ACS, most (57%) presented with abnormal glucose metabolism (Figure 1).”
- Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
“Most patients (699 of 1,199, 57%) who presented with ACS had an abnormal metabolism, which was defined as a diagnosis of DM on admission (n ϭ 321, 27%), a new diagnosis of DM (n ϭ 126, 14%), or impaired fasting glucose metabolism (n ϭ 252, 29%).”
Quote in the paperSubstantial claim - Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
- Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Patients recognized as having diabetes mellitus had a higher mean body mass index (31.0 ± 6.1 kg/m2) than those not recognized (28.4 ± 5.8 kg/m2), p = 0.02.
“Statistical analysis of predictors of patients who were more likely to be recognized as having DM included a higher BMI (31.0 Ϯ 6.1 kg/m 2 for those recognized as having DM vs 28.4 Ϯ 5.8 for those not recognized as having DM, p ϭ 0.02”
Quote in the paperNot a substantial claim - Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Among the 878 acute coronary syndrome patients without a prior diabetes diagnosis, 126 (14%) met the fasting plasma glucose criterion of at least 126 mg/dl for new-onset diabetes mellitus.
“Using a FPG level Ն126 mg/dl as a diagnostic criterion, 126 (14%) of the remaining 878 patients were classified as having new-onset DM (Figure 2).”
- Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
“After excluding these, an additional 126 of 878 patients (14%) met criteria for a diagnosis of new-onset DM.”
Quote in the paperSubstantial claim - Also stated in: § Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome · plain
- Interpretationown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Because the study population was predominantly white men from the Midwest of the United States, the findings may not be representative of other populations.
“our study population consisted predominantly of white men from the Midwest of the United States and thus may not be representative of other populations.”
Quote in the paperNot a substantial claim - Interpretationreasoning§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome
Screening patients presenting with acute coronary syndrome using a simple fasting plasma glucose test is one way to identify some patients with undiagnosed diabetes mellitus.
“it follows that 1 way to”
Quote in the paperSubstantial claim- Rests on an assumption: No prior study had described practice patterns in evaluating high-risk patients with acute coronary syndrome for the diagnosis of diabetes mellitus.
- May combine two claims. 4
- Classified as probably not a substantial claim. 5
- The quote only partly states this claim. 1
May combine two claims.
Findingown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromeAmong the 878 patients without prior diabetes, 252 (29%) met criteria for impaired fasting glucose, and none of them received that diagnosis.
“Importantly, we found a substantial number of patients who had high FPG levels (252 of 878, 29%), thus qualifying them for a diagnosis of impaired fasting glucose level.None of these patients received such a diagnosis (Figure 2).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromeThree physicians reviewed the charts of all patients with remaining diagnostic uncertainty and reached consensus on the final diagnosis.
“Three physicians reviewed the charts of all patients for whom diagnostic uncertainty remained and attained consensus on the final diagnosis.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Interpretationreasoning§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromeGrouping the 278 patients without available fasting plasma glucose values together with those having normal glucose metabolism under-represented patients with abnormal glucose metabolism.
“We included these patients with those who had”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromeA recent study suggested that most patients newly diagnosed with diabetes mellitus during hospitalization for acute coronary syndrome continue to have increased glucose levels after 3 months.
“a recent study has suggested that most patients who have DM that is newly diagnosed during hospitalization for ACS continue to have increased glucose levels after 3 months.5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Tenerz, 2003, Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes, Diabetes Care source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
Premisecitation§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromeDiabetes mellitus is regarded by many as a coronary atherosclerotic disease equivalent.
“Because DM is considered by many to be a coronary atherosclerotic disease equivalent, 1”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1] 2001, Executive summary of the 3rd report of the National Cholesterol Expert Panel on detection, evaluation, and treatment of elevated blood cholesterol in adults (ATPIII), JAMA source
Not checked in the free run.
May combine two claims.
Interpretationcitation§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromeThis study confirms earlier trials indicating that diabetes mellitus is often unrecognized and uncontrolled in patients presenting with acute myocardial infarction.
“This study confirms previous trials that suggested that DM is often unrecognized and uncontrolled in patients who present with an acute myocardial infarction.4”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4] Norhammar, 2002, Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus, Lancet source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromePatients with diabetes mellitus or the metabolic syndrome are at markedly higher risk for recurrent cardiovascular events after acute coronary syndrome.
“Patients who have DM or the metabolic syndrome are at markedly higher risk for recurrent cardiovascular events after ACS. 5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Tenerz, 2003, Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes, Diabetes Care source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown data§ Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary SyndromeInstitutional review board approval from both institutions was obtained before the study, and each participant signed informed consent for the interviews and chart abstractions.
“Approval from the institutional review boards of the 2 institutions was obtained before conducting the study, and an informed consent to participate in the interviews and chart abstractions was signed by each participant.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
No prior study had described practice patterns in evaluating high-risk patients with acute coronary syndrome for the diagnosis of diabetes mellitus.
“To date, no study has described practice patterns in evaluating high-risk patients who have acute coronary syndrome (ACS) for the diagnosis of diabetes mellitus (DM).”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
About one-third of American adults and two-thirds of coronary artery disease patients have abnormal glucose homeostasis.
“Recent studies indicate that about one-third of American adults and two-thirds of CAD patients have abnormal glucose homeostasis (6,7).”
From Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health (2008) · cites this paper as [6]
The results (Figure 1; page unavailable) report abnormal glucose metabolism in 57% of patients presenting with acute coronary syndrome, which supports a high prevalence in that group but not the stated two-thirds of CAD patients generally. The discussion also reports roughly two-thirds in another acute-coronary cohort. Our copy provides no estimate for American adults. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Abnormal glucose prevalence is misstated
MajorThe reported count is 58.3% of the cohort, not 57%. This affects the paper's headline prevalence result.
Reported 57 · recomputed 58.298582
“Figure1.Most patients (699 of 1,199, 57%) who presented with ACS had an abnormal metabolism”
Impaired fasting glucose diagnoses are reported both as given and absent
MinorThe results say none of the 252 patients received an impaired fasting glucose diagnosis, whereas the Figure 2 caption says all 252 received a new diagnosis.
“None of these patients received such a diagnosis (Figure 2).”
“Another 252 of 878 patients (29%) received a new diagnosis of impaired fasting glucose metabolism.”
Primary outcome formula counts recognized cases instead
MinorThe stated formula uses newly recognized cases as its numerator, yielding the recognized proportion. The results identify the unrecognized proportion as the remaining 82 of 126 patients.
“The primary purpose of this study was to describe the proportion of patients who had unrecognized DM.This percentage was calculated as the ratio of patients who had newly recognized DM divided by the number of patients who entered the hospital without a known diagnosis of DM and who had laboratory parameters consistent with the diagnosis of DM.”
“The remaining 82 patients (65%) who met criteria for a new diagnosis of DM were not recognized by the team that provided care for patients' ACS.”
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- Authors
- Conaway, D. G., O’Keefe, J. H., Reid, K. J., & Spertus, J.
- Affiliations
- Truman Medical Center (US)
- Saint Luke's Hospital (US)
- Corresponding author
- Conaway, Darcy Green
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-08
- Volume
- 96
- Issue
- 3
- Pages
- 363-365
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2076291204
- Cited by
- 80
- References
- 7
- Citations by year
- 2025: 1 · 2022: 6 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 5 · 2017: 1 · 2016: 7 · 2015: 8 · 2014: 7 · 2013: 6 · 2012: 2
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R-01 HS11282-01)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- undiagnosed diabetes, acute coronary syndrome, fasting blood glucose, abnormal glucose metabolism, diabetes diagnosis, underdiagnosis, coronary artery disease
- MeSH terms
- Angina, Unstable, Blood Glucose, Diabetes Mellitus, Female, Humans, Male, Missouri, Myocardial Infarction, Prospective Studies, Prevalence, Chi-Square Distribution
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