Is admission blood glucose concentration a more powerful predictor of mortality after myocardial infarction than diabetes diagnosis? A retrospective cohort study

Gholap, Nitin; Mehta, Rajnikant; Ng, Leong L.; Davies, Melanie J.; Khunti, Kamlesh; Squire, Iain B.

doi:10.1136/bmjopen-2012-001596

Cited by 20 publications

(20 citation statements)

References 28 publications

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“…(Rydén et al 2013). In patients with ACS, the recommended appropriate screening method is an OGTT, performed at least 4 to 5 days after the initial coronary event to minimize the risk of false positive results (Rydén et al 2013).Admission blood glucose was found to be strongly associated with mortality in patients with myocardial infarction (Gholap et al 2012) and current evidence on prognostic role of hyperglycaemia in ACS allows us to suggest its direct involvement in short term complications (De Caterina et al 2010).…”

Section: Discussionmentioning

confidence: 99%

“…There is increasing recognition of the significant relationship between diabetes and cardiovascular disease, and the contribution that each of these conditions makes to the risk of morbidity and mortality from both diseases (Rydén et Gholap et al 2012;De Caterina et al 2010). Coronary artery disease is common in patients with true dysglycaemic syndromes (DS) which includes diabetes mellitus (DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT) (Gerstein et al 1996).…”

Section: Introductionmentioning

confidence: 99%

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Importance of Investigating Mild Hyperglycaemia Using Oral Glucose Tolerance Test in the Setting of Acute Coronary Syndrome: Prospective Investigational Study

Dissanayake¹,

Quek²,

Zeng³

et al. 2013

DIAB

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The aim of this article is to estimate the prevalence of true dysglycaemic syndromes (DS) (includes presence of diabetes mellitus [DM], impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in patients with acute coronary syndromes (ACS) and mild fasting hyperglycaemia from an area in New Zealand with the country's highest prevalence of dysglycaemia. Cardiac risk factor data and laboratory findings for 565 consecutive ACS patients were obtained from the hospital database between January 2007 and August 2008. On admission, 175 patients had DS and 168 were normoglycaemic (FBG <5.6 mmol/L). The remaining 222 patients (with previously unknown glycaemic status) had mild fasting hyperglycaemia .9 mmol/L) on admission. This group with mild fasting hyperglycaemia were offered oral glucose tolerance testing (OGTT) >3 months post-discharge to eliminate cases of stress hyperglycaemia. 121 patients underwent OGTT and 41 patients (a third) were found to have true DS (DM in 13, IGT or IFG in 28). Patients who did not undergo OGTT due to a variety of reasons (n=101) had significantly higher body mass index, waist circumference, and higher concentrations of triglycerides and low-density lipoprotein cholesterol, and therefore might be at a higher risk for true DS than those tested. The conclusion is that a third of the OGTT cohort had true DS and therefore even mild hyperglycaemia in this setting should be carefully investigated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Importance of Investigating Mild Hyperglycaemia Using Oral Glucose Tolerance Test in the Setting of Acute Coronary Syndrome: Prospective Investigational Study

Dissanayake¹,

Quek²,

Zeng³

et al. 2013

DIAB

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“…170 Therefore, it was imperative to develop a culturally informed and appropriate intervention for this at-risk population, whose dietary practices and frequently reported low levels of physical activity contribute to the onset of T2DM. 144 At the time of developing the Let's Prevent programme, studies investigating the prevention of diabetes mellitus in migrant populations in the UK were lacking.…”

Section: Drafting a Curriculum For Black And Minority Ethnic Participmentioning

confidence: 99%

A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial

Davies

Gray

Ahrabian

et al. 2017

Programme Grants Appl Res

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BackgroundPrevention of type 2 diabetes mellitus (T2DM) is a global priority; however, there is a lack of evidence investigating how to effectively translate prevention research into a primary care setting.Objectives(1) To develop and validate a risk score to identify individuals at high risk of T2DM in the UK; and (2) to establish whether or not a structured education programme targeting lifestyle and behaviour change was clinically effective and cost-effective at preventing progression to T2DM in people with prediabetes mellitus (PDM), identified through a risk score screening programme in primary care.DesignA targeted screening study followed by a cluster randomised controlled trial (RCT), with randomisation at practice level. Participants were followed up for 3 years.SettingA total of 44 general practices across Leicestershire, UK. The intervention took place in the community.ParticipantsA total of 17,972 individuals from 44 practices identified through the risk score as being at high risk of T2DM were invited for screening; of these, 3449 (19.2%) individuals attended. All received an oral glucose tolerance test. PDM was detected in 880 (25.5%) of those screened. Those with PDM were included in the trial; of these, 36% were female, the average age was 64 years and 16% were from an ethnic minority group.InterventionPractices were randomised to receive either standard care or the intervention. The intervention consisted of a 6-hour group structured education programme, with an annual refresher and regular telephone contact.Main outcome measuresThe primary outcome was progression to T2DM. The main secondary outcomes were changes in glycated haemoglobin concentrations, blood glucose levels, cardiovascular risk, the presence of metabolic syndrome, step count and the cost-effectiveness of the intervention.ResultsA total of 22.6% of the intervention group did not attend the education and 29.1% attended all sessions. A total of 131 participants developed T2DM (standard care,n = 67; intervention,n = 64). There was a 26% reduced risk of T2DM in the intervention arm compared with standard care, but this did not reach statistical significance (hazard ratio 0.74, 95% confidence interval 0.48 to 1.14;p = 0.18). There were statistically significant improvements in glycated haemoglobin concentrations, low-density lipoprotein cholesterol levels, psychosocial well-being, sedentary time and step count in the intervention group. The intervention was found to result in a net gain of 0.046 quality-adjusted life-years over 3 years at a cost of £168 per patient, with an incremental cost-effectiveness ratio of £3643 and a probability of 0.86 of being cost-effective at a willingness-to-pay threshold of £20,000.ConclusionsWe developed and validated a risk score for detecting those at high risk of undiagnosed PDM/T2DM. We screened > 3400 people using a two-stage screening programme. The RCT showed that a relatively low-resource pragmatic programme may lead to a reduction in T2DM and improved biomedical and psychosocial outcomes, and is cost-effective.LimitationsOnly 19% of those invited to screening attended, which may limit generalisability. The variation in cluster size in the RCT may have limited the power of the study.Future workFuture work should focus on increasing attendance to both screening and prevention programmes and offering the programme in different modalities, such as web-based modalities. A longer-term follow-up of the RCT participants would be valuable.Trial registrationCurrent Controlled Trials ISRCTN80605705.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Introductionmentioning

confidence: 99%

“…1,2 Admission hyperglycaemia appears to be more strongly associated with subsequent mortality than a prior diagnosis of diabetes. 1 Furthermore, normalisation of glucose after admission has been associated with better survival in hyperglycaemic patients with ACS whether or not they are treated with insulin, 3 although a recent report raised the possibility that intravenous insulin infusions may only be of benefit for ST segment elevation myocardial infarction. 4 While there is a powerful pathophysiological basis for the toxicity of glucose in the context of acute coronary ischaemia based on oxidative stress, 5,6 enhanced platelet activation and thrombin formation, 7 and impaired response to antiplatelet drugs, 8 the evidence base for the value of intravenous insulin given to lower glucose in ACS is weak.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS

et al. 2015

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Aim: To assess the safety and efficacy of a variable rate intravenous insulin infusion to lower blood glucose (BG) in patients presenting with acute coronary syndrome and hyperglycaemia. Methods: We evaluated the response over 24 hours of a variable rate insulin infusion with 5% dextrose and potassium chloride (40 mEq/L), to control hyperglycaemia in 776 patients with an admission BG ≥10 mmol/L in 36 UK hospitals. Patients had either ST segment elevation or non-ST segment elevation myocardial infarction and the study included both patients with or without a diagnosis of diabetes. We measured blood glucose, initially hourly, and serum potassium at admission, at 24 hours and at the time of major arrhythmias. We measured survival to 30 days.

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Is admission blood glucose concentration a more powerful predictor of mortality after myocardial infarction than diabetes diagnosis? A retrospective cohort study

Cited by 20 publications

References 28 publications

Importance of Investigating Mild Hyperglycaemia Using Oral Glucose Tolerance Test in the Setting of Acute Coronary Syndrome: Prospective Investigational Study

Importance of Investigating Mild Hyperglycaemia Using Oral Glucose Tolerance Test in the Setting of Acute Coronary Syndrome: Prospective Investigational Study

A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial

An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS

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