No abstract

Abnormal glucose tolerance is a strong risk factor for future cardiovascular events after myocardial infarction. Since it is common and possible to detect even during the hospital phase it may be a target for novel secondary preventive efforts.

OBJECTIVE—Individuals with diabetes have an increased morbidity from acute myocardial infarction (AMI). Based on an oral glucose tolerance test (OGTT), 40–45% of patients with AMI have diabetes. The objective of this study was to characterize the glucometabolic profile of patients with AMI without known diabetes and to see if sustained glucometabolic perturbations are predictable during the hospital phase of the disease. RESEARCH DESIGN AND METHODS—A total of 145 patients with AMI and no previous diagnosis of diabetes were subjected to an OGTT at hospital discharge and 3 months thereafter. Based on the OGTT after 3 months, they were defined as having normal glucose tolerance (NGT; n = 50), impaired glucose tolerance (IGT; n = 59), or diabetes (n = 36). Components of the metabolic syndrome, including insulin resistance assessed by homeostasis model assessment (HOMA-IR), were recorded. RESULTS—Patients with AMI had no changes in insulin resistance from hospital discharge to follow-up. An OGTT and/or a single blood glucose taken 60 min (BG-60) after ingestion of 75 g glucose at hospital discharge were predictors of the outcome of the OGTT at follow-up. With a cutoff value for BG-60 of 8.6 mmol/l, 70% of the patients were correctly predicted as either belonging to the NGT group or the IGT/diabetes group after 3 months. Age, BMI, antihypertensive treatment, HbA1c, fasting blood glucose, blood lipids, insulin, proinsulin, HOMA-IR, and plasminogen activator inhibitor 1 did not add predictive power. CONCLUSIONS—Patients with AMI and no previous diagnosis of diabetes have no changes in insulin resistance from hospital discharge to a 3-month follow-up. An OGTT or a single BG-60 performed at hospital discharge predicts the diagnosis of IGT or diabetes 3 months thereafter.

OBJECTIVE -Previously undetected glucose abnormalities are common in patients with acute myocardial infarction (AMI). We evaluated long-term reliability of early glucometabolic classification of patients with AMI by repeated oral glucose tolerance tests (OGTTs). RESEARCH DESIGN AND METHODS-A glucometabolic OGTT-based classification was obtained in 122 patients by measuring capillary whole-blood glucose. The classification was performed on three occasions, before hospital discharge and 3 and 12 months thereafter.RESULTS -At discharge, 34, 31, and 34% were classified as having normal glucose tolerance, impaired glucose tolerance (IGT), or type 2 diabetes, respectively, and 93% of all patients with type 2 diabetes were still classified with type 2 diabetes (n ϭ 27) or IGT (n ϭ 12) after 12 months. The agreements between the OGTTs at discharge and 3 and 12 months were ϭ 0.35, P Ͻ 0.001, and ϭ 0.43, P Ͻ 0.001, respectively. CONCLUSIONS -The outcome of an OGTT performed in AMI patients at hospital discharge reliably informs on long-term glucometabolic state. Diabetes Care 31:36-38, 2008I n recent years, focus has been devoted to the high prevalence of previously undiagnosed glucose abnormalities in patients with acute myocardial infarctions (AMIs) as reported by the GAMI (Glucose tolerance in Acute Myocardial Infarction [1]) Study and subsequently confirmed by the Euro and China Heart Surveys (2,3). These findings attracted further attention when it recently became evident that postinfarction patients with newly detected disturbed glucose metabolism are at an increased risk for cardiovascular morbidity and mortality (4,5), emphasizing the importance of diagnosing these patients at an early stage.Classification of glucose abnormalities should, according to the World Health Organization (WHO) (6), be based on fasting and postload plasma glucose obtained by a standardized oral glucose tolerance test (OGTT), while the most recent American Diabetes Association (ADA) criteria (7) includes fasting blood glucose only. The latter method will, however, identify only about onethird of individuals defined with newly detected diabetes by means of an OGTT (1,8,9).This analysis from the GAMI Study aimed at investigating the long-term reliability of early classification of glucose abnormalities using OGTT in patients with AMI without previously known type 2 diabetes. RESEARCH DESIGN ANDMETHODS -A detailed description of the GAMI Study has been presented elsewhere (1). The inclusion criteria were suspected AMI, no previously known diabetes, baseline capillary blood glucose Ͻ11.1 mmol/l, serum creatinine Ͻ200 mol/l, and age Յ80 years. A total of 181 participants were enrolled, of whom 168 were characterized on discharge after an OGTT as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or type 2 diabetes. The present report is based on the 122 patients, who at all occasions during follow-up (discharge and 3 and 12 months) could be reclassified into the three groups.A standardized OGTT (75-g glucose in 200 ml wate...

Abstract. Bartnik M, Malmberg K, Hamsten A, Efendic S, Norhammar A, Silveira A, Tenerz Å , Ö hrvik J, Rydén L (Karolinska University Hospital, Solna; Karolinska Institutet, Stockholm; and Västerås Hospital, Västerås, Sweden). Abnormal glucose tolerance -a common risk factor in patients with acute myocardial infarction in comparison with population-based controls.