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Glucose metabolism

Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study.

Norhammar A et al Lancet. 2002 22;359:2140

Department of Cardiology, Karolinska Hospital, 171 76 Stockholm, Sweden. anna.norhammer@ks.se

BACKGROUND: Glycometabolic state at hospital admission is an important risk marker for long-term mortality in patients with acute myocardial infarction, whether or not they have known diabetes mellitus. Our aim was to ascertain the prevalence of impaired glucose metabolism in patients without diagnosed diabetes but with myocardial infarction, and to assess whether such abnormalities can be identified in the early course of a myocardial infarction.

METHODS: We did a prospective study, in which we enrolled 181 consecutive patients admitted to the coronary care units of two hospitals in Sweden with acute myocardial infarction, no diagnosis of diabetes, and a blood glucose concentration of less than 198 mg/dl. We recorded glucose concentrations during the hospital stay, and did standardized oral glucose tolerance tests with 75 g of glucose at discharge and again 3 months later.

FINDINGS: The mean age of our cohort was 63.5 years (SD 9) and the mean blood glucose concentration at admission was 117 mg/dl. The mean 2-h postload blood glucose concentration was 101 mg/dl at hospital discharge, and 99 mg/dl 3 months later. 58 of 164 (35%) and 58 of 144 (40%) individuals had impaired glucose tolerance at discharge and after 3 months, respectively, and 51 of 164 (31%) and 36 of 144 (25%) had previously undiagnosed diabetes mellitus. Independent predictors of abnormal glucose tolerance at 3 months were concentrations of HbA(1c) at admission (p=0.024) and fasting blood glucose concentrations on day 4 (p=0.044).

INTERPRETATION: Previously undiagnosed diabetes and impaired glucose tolerance are common in patients with an acute myocardial infarction. These abnormalities can be detected early in the postinfarction period. Our results suggest that fasting and postchallenge hyperglycaemia in the early phase of an acute myocardial infarction could be used as early markers of high-risk individuals.

Comment:  Diabetes and heart disease are closely linked and the heart disease often occurs before you even know you have diabetes. Our HbA1c screening helps pick up early diabetes even before blood sugars get very high.  GLE

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