OBJECTIVE The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods. RESEARCH DESIGN AND METHODS Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden’s J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients. RESULTS Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong. CONCLUSIONS Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks.

中文翻译：

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胰岛素抵抗测量作为冠状动脉疾病患者血糖异常的筛查工具：来自 EUROASPIRE V 人群的报告

目的 对冠状动脉疾病 (CAD) 患者血糖异常（包括 2 型糖尿病和糖耐量降低）的最佳筛查策略存在争议。我们检验了假设，即通过 HOMA 指数测量胰岛素抵抗可能构成良好的筛选方法。研究设 计算了三个不同的HOMA指标：胰岛素抵抗的HOMA（HOMA-IR）、基于胰岛素的HOMA2（HOMA2-ins）和基于C肽的HOMA2（HOMA2-Cpep）。根据从 OGTT 获得的 2 小时负荷后血糖值诊断血糖异常。通过标准化访谈获得研究参与者的信息。3个HOMA指标对血糖异常诊断的最佳阈值是通过在接受者操作特征曲线上的Youden's J统计量的最大值得到的。通过 Spearman 系数评估它们与临床参数的相关性。结果 在 3,534 名 CAD 患者（平均年龄 63 岁；25% 女性）中，41% 患有血糖异常。新检测到的血糖异常患者与未检测到血糖异常的患者的平均胰岛素、C 肽和 HOMA 指数显着升高（所有 P < 0.0001）。三个HOMA指标诊断血糖异常的敏感性和特异性均较低，但与BMI和腰围的相关性较强。结论 HOMA-IR、HOMA2-ins、