Serum albumin-enhanced screening: A triage strategy and predictive model for OGTT in community-managed patients with coronary heart disease.

BackgroundPatients with coronary heart disease (CHD) are at high risk of undiagnosed diabetes. Reliance on standard fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) may lead to underdiagnosis, highlighting the need for optimized screening strategies.MethodsUsing data from the National Health and Nutrition Examination Survey (NHANES) cycles 2007-2016, we analyzed 287 patients with CHD and 8,904 non-CHD controls without pre-existing diabetes. A two-tier protocol was implemented, consisting of initial FPG/HbA1c screening followed by OGTT. A prediction model was derived to identify individuals at high risk for OGTT-dependent diabetes.ResultsPatients with CHD had a 3.4-fold higher weighted prevalence of newly diagnosed diabetes than controls (22.1% [95% CI, 16.5%-28.8%] vs. 6.5% [95% CI, 5.8%-7.2%]). Initial FPG/HbA1c screening missed 32 of 64 diabetes cases (50.0%), which were detectable only by OGTT. The albumin-enhanced model (HbA1c + FPG + albumin) demonstrated robust discriminatory capacity (AUC 0.823) and provided significant incremental value over the HbA1c + FPG model, with an integrated discrimination improvement of 0.0611 and net reclassification improvement of 0.1562 (both P<0.05).ConclusionSerum albumin is an adjunctive biomarker that enhances prediction. Our model may provide an effective triage strategy for targeting OGTT in high-risk individuals, enhancing screening efficiency.