Beta cell dysfunction in patients with acute myocardial infarction but without previously known type 2 diabetes: a report from the GAMI study

Abstract

Aims/hypothesis: Patients with acute myocardial infarction (AMI) but without previously known type 2 diabetes have a high prevalence of undiagnosed IGT and type 2 diabetes. Such perturbations have dismal prognostic implications. The aim of this study was to characterise AMI patients in terms of insulin resistance and beta cell function. Methods: A total of 168 consecutive AMI patients were classified by means of an OGTT before hospital discharge as having NGT, IGTor type 2 diabetes. The homeostasis model assessment (HOMA-IR) was used to estimate insulin resistance. Beta cell responsiveness was quantified as insulinogenic index (IGI) at 30 min (ΔI 30 /ΔG 30 (r=−0.218, p=0.010) and to the area under the curve for glucose (r=−0.475, p<0.001). Conclusions/interpretation: Glucose abnormalities are very common in patients with AMI but without previously known type 2 diabetes. To a significant extent, this seems to be related to impaired beta cell function and implies that dysglycaemia immediately after an infarction is not a stress epiphenomenon but reflects stable disturbances of glucose regulation preceding the AMI. Early beta cell dysfunction may have important pathophysiological implications and may serve as a future target for treatment strategies.

Insulin-like growth factor I: a predictor of long-term glucose abnormalities in patients with acute myocardial infarction

“…A previous evaluation of the present patients revealed that they had beta cell dysfunction [24]. It has been speculated that the combination of low IGF-I and decreased insulin function makes the patient more prone to developing AGT, causing a high postprandial glucose level [25] which has been shown to be a more apparent predictor of subsequent cardiovascular events than fasting glucose [26].…”

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

“…The prognostic role of hyperglycemia has also been reported in cardiogenic shock complicating acute myocardial infarction [9][10][11][12]. Insulin resistance, known to be part of the glyco-metabolic response to stress, has been investigated in a few studies by means of the Homeostatic Model Assessment (HoMA index), in the early phase of acute myocardial infarction [13] and in ACS patients [14]. In non-diabetic STEMI patients submitted to PCI, we report that insulin resistance, as assessed by HOMA-index, is quite common, and helps in the early risk stratification, since it represents an independent predictor for in-hospital mortality [15].…”

The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia

“…Insulin resistance is known to be part of the glycometabolic response to stress, but few studies assessed the role of insulin resistance, evaluated by means of Homeostatic Model Assessment (HOOMA index), in the early phase of acute myocardial infarction [12,13]. In non-diabetic STEMI patients undergone PCI, we reported that insulin resistance, as assessed by HOMA index, is quite common and helps in the early risk stratification, since it represents an independent predictor for in-hospital mortality [14].…”