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Can patients presenting with acute coronary syndrome be screened for diabetes using glycosylated haemoglobin?

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The prevalence of diabetes in Australia is 7.4%.1 However, it is three times higher in patients admitted to hospital with acute coronary syndrome (ACS).2 It often remains undetected, and the prevalence of unrecognised diabetes in ACS populations is estimated to be 4%–22%.3 Diabetes is an independent predictor of increased mortality risk after myocardial infarction,4 so that early detection is of particular importance. In Australia, the incorporation of elevated glycosylated haemoglobin (HbA1c) levels (≥ 48 mmol/mol) into the diagnostic criteria for diabetes in 2012 has facilitated its diagnosis in hospital admissions for ACS.5 HbA1c levels are not affected by the acute stress of the ACS event, and their assessment does not require a fasting sample. We assessed the feasibility of routinely collecting HbA1c data as part of a prospective cohort study of consecutive ACS admissions to Monash Health, Victoria. We enrolled patients from 1 January 2013 to 30 June 2014 who were over 21 years of age and fluent in English. HbA1c was routinely assayed by high-performance liquid chromatography (Arkray Adams Glycohaemoglobin Analyzer HA-8160). The study participants were relatively young, and most were men (Box). Assessment of the prevalence…