Glucose Intolerance Is Common in Japanese Patients With Acute Coronary Syndrome Who Were Not Previously Diagnosed With Diabetes

Abstract

OBJECTIVE -Postprandial hyperglycemia has emerged as a new glycometabolic condition associated with an excessive risk for coronary artery disease. We therefore attempted to evaluate the frequency of postchallenge hyperglycemia in patients with acute coronary syndrome (ACS) who were not previously diagnosed to have diabetes and did not have a fasting glucose concentration of Ն7 mmol/l or an HbA 1c level Ͼ6.0%. We further correlated the presence of postchallenge hyperglycemia with the extent of coronary atherosclerosis. RESEARCH DESIGN AND METHODS-In all, 134 consecutive ACS patients who met the above inclusion criteria were studied. An oral glucose tolerance test was performed before discharge.RESULTS -The mean age, fasting glucose, and HbA 1c were 60 years, 5.15 mmol/l, and 5.4%, respectively. Among ACS patients, impaired glucose tolerance (IGT) and diabetes were found in 50 (37%) and 13 patients (10%), respectively. The homeostasis model assessment for insulin resistance did not differ substantially among the normal glucose tolerance (NGT), IGT, and diabetic groups. Insulinogenic index, however, was lower and the number of stenosed vessels higher in diabetic patients compared with NGT patients.CONCLUSIONS -Postchallenge hyperglycemia, caused primarily by impaired initial insulin secretion, is commonly found in Japanese ACS patients who have not been previously diagnosed with diabetes, and this phenomenon is considered to be associated with advanced coronary atherosclerosis. Therefore, the present study strongly supports the notion that oral glucose tolerance test assessment of postchallenge hyperglycemia is essential to identify any previously undiagnosed diabetes cases among Japanese ACS patients. Diabetes Care 28:1182-1186, 2005T he number of diabetic patients in Japan is now estimated to be Ͼ6.8 million (1). Furthermore, the number of diabetic patients in Japan and other southeastern Asian countries is expected to increase at the fastest rate worldwide. This trend, together with its associated complications that involve a substantial utilization of resources, make diabetes an extremely important health problem in Japan.Impaired insulin secretion or/and impaired insulin sensitivity play a pivotal role in the development of type 2 diabetes. Possible contributions of these two factors have been shown to be ethnicity dependent to some extent (2,3). In the Caucasian population, a decreased insulin sensitivity is a primary metabolic defect underlying glucose intolerance, whereas an impaired insulin secretion mainly accounts for glucose intolerance in the Japanese population, among other Asian populations (4,5). As a consequence, Caucasian diabetic patients are often accompanied by obesity and increased fasting glucose concentrations, whereas Japanese counterparts are relatively lean and having normal fasting glucose levels but increased postprandial hyperglycemia.An increased prevalence of glucose intolerance has been previously reported in patients with acute coronary syndrome (ACS) in a European population (6). ...

Blood Glucose and Coronary Artery Disease in Nondiabetic Patients

“…Both the relative risk for coronary disease and the progressive increase in incidence that appeared to approach 30% after 8 years indicate that modest increases in blood glucose are associated with an increased incidence of CAD. These results extend previous descriptions of the association between elevated glucose and CAD (4,8,15,16) and confirm that commonly used morning glucose determinations can provide a significant indication of CAD risk.…”

“…Pathologic consequences from modest elevations of glucose are plausible since impaired glucose tolerance and impaired fasting glucose have been associated with macrovascular disease (6) and greater mortality (7). Patients presenting with acute coronary syndrome frequently have glucose intolerance (8), and it has been reported that glucose intolerance but not impaired fasting glucose may be associated with CAD (5,9). In contrast, meta-analysis indicates that glucose above a threshold of 100 mg/dl may also be a significant risk (10).…”

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

“…Therefore, we wanted to further investigate the pathogenesis of AGT by estimating beta cell function in this specific patient group. Although disturbed glucose regulation is a common characteristic of patients with AMI, specific attention has not, until very recently [19], been devoted to beta cell dysfunction in these patients.…”

A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease

“…In fact, cross-sectional studies have found only 35-54% of IHD patients have normal glucose tolerance (NGT) [5][6][7][8][9][10][11]. Increased physical activity, healthy food choices and decreased waist circumference may help to lower the rate of progression from IGT to diabetes [12][13][14].…”