Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction

Bartnik, M.; Malmberg, Klas; Norhammar, Anna; Tenerz, Åke; Öhrvik, John; Rydén, Lars

doi:10.1016/j.ehj.2004.09.021

Cited by 244 publications

(202 citation statements)

References 23 publications

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“…Similarly, undiagnosed diabetes and pre-diabetes have been reported in other clinical situations, e.g., in patients with myocardial infarction, 8 and have been shown to be associated with long-term outcomes. 9 Hyperglycemia is associated with micro and macro vascular disease, and patients with undiagnosed type 2 diabetes are at a significantly increased risk of obesity, hypertension, coronary artery disease, peripheral vascular disease, and cerebrovascular accidents that can contribute to increased perioperative morbidity and mortality. 10 Emerging retrospective data are supporting the notion that hyperglycemia is harmful in the perioperative setting.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

Abdelmalak

Knittel

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Given that preoperative hyperglycemia is associated with poor outcomes and many non-diabetic patients have high plasma glucose (PG) levels, the purpose of our study was to estimate the prevalence of undiagnosed diabetes among non-cardiac surgery patients and to identify predictors of hyperglycemia in non-diabetics. MethodsWe included all non-cardiac surgery patients with complete records in the Clinical Database of the Anesthesiology Institute at the Cleveland Clinic during January 2007 to April 2009, and we estimated the prevalence of undiagnosed diabetes and impaired fasting glucose (IFG) among the non-diabetic patients. The mean glucose levels for known diabetics and undiagnosed diabetics were compared using two-tailed Student's t tests, and we assessed the association between PG levels and demographic variables within the non-diabetics. Results Of the 39,434 patients analyzed, 5,511 (14%) were known diabetics. Of the 33,923 known non-diabetics, 3,426 (10 %) were undiagnosed diabetics and another 3,549 (11%) had IFG. Thus, 6,975 patients (21%) of the non-diabetic patients presented with abnormally high glucose. Previously undiagnosed diabetics had higher preoperative glucose levels compared with known diabetics, with a mean ± standard deviation (SD) of 161 ± 48 vs 146 ± 67 mgÁdL -1 (8.9 ± 2.7 vs 8.1 ± 3.7 mmoLÁL -1 ), respectively. The difference remained highly significant after adjusting for body mass index, age, sex, and American Society of Anesthesiologists (ASA) physical status (P \ 0.001). Among non-diabetics, older age, obesity, male sex, and a higher ASA physical status were collectively significant predictors of hyperglycemia, with a c-statistic (95% confidence interval) of 0.67 (0.66-0.68). Conclusion A significant proportion of non-cardiac surgery patients have previously undiagnosed diabetes and pre-diabetes. Previously undiagnosed patients have higher fasting glucose levels compared with diabetic patients. Further studies should be conducted to identify the implications of these findings on patient outcomes. RésuméObjectif E´tant donne´que l'hyperglyce´mie pre´ope´ratoire est associe´e à un mauvais pronostic et que de nombreux Preliminary results were presented at

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Section: Discussionmentioning

confidence: 99%

The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

Abdelmalak

Knittel

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…A detailed description of the patients has been presented elsewhere [4,5]. In brief, patients admitted for AMI were included if they fulfilled the following inclusion criteria: no previously known type 2 diabetes, baseline capillary blood glucose <11.1 mmol/l, serum creatinine <200 μmol/l and age ≤80 years.…”

Section: Subjectsmentioning

confidence: 99%

“…Intraand interassay coefficients of variation for these analyses were 6% and 7%, respectively, for insulin and 5% and 6% for proinsulin. Details of biochemical analysis have been described elsewhere [4,5,14].…”

Section: Study Protocolmentioning

confidence: 99%

“…In the GAMI (Glucose Tolerance in Patients with Acute Myocardial Infarction) study, OGTTs performed on patients without previously known type 2 diabetes but with an acute myocardial infarction (AMI) demonstrated that 35% had impaired glucose tolerance (IGT) and 31% had previously undiagnosed type 2 diabetes [4]. Newly detected abnormal glucose tolerance (AGT; IGT or type 2 diabetes) was the strongest predictor of future cardiovascular events, together with previous myo-cardial infarction and stroke [5]. Type 2 diabetes is characterized by decreased insulin sensitivity and progressive beta cell dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2005

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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.

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“…Glucometabolic status evaluated by two-hour post-load glycaemia (2h-PG) during oral glucose tolerance test (OGTT) has been a well-established risk factor for worse prognosis in patients with acute myocardial infarction (AMI) [1][2][3][4]. Newly detected diabetes mellitus (DM) or impaired glucose tolerance were associated with similar mortality to pre-hospital diabetes [5].…”

Section: Introductionmentioning

confidence: 99%

Long-term prognosis is related to mid-term changes of glucometabolic status in patients with acute myocardial infarction treated invasively

et al. 2017

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A b s t r a c tBackground: Glucometabolic status (GS) in patients with acute myocardial infarction (AMI) has an impact on prognosis, but it may change over time. Aim:To evaluate the prognosis after AMI treated invasively with respect to changes in GS assessed by oral glucose tolerance test at discharge and at mid-term follow-up visit (FU-visit).Methods: Glucometabolic status was assessed by two-hour post-load glycaemia and defined as abnormal glucose tolerance (AGT) or normal glucose tolerance (NGT). Out of 454 in-hospital AMI survivors, 368 (81%) patients completed an FU-visit and were divided into four groups with respect to GS at discharge and FU-visit: group 1 -AGT at discharge and FU-visit (n = 101); group 2 -AGT at discharge and NGT at FU-visit (n = 48); group 3 -NGT at discharge and AGT at FU-visit (n = 114); and group 4 -NGT at discharge and FU-visit (n = 105). All-cause mortality was compared between groups with log-rank test.Results: Median time from AMI to FU-visit was seven months. Median remote follow-up duration after AMI was 31 months. Two-hour post load glycaemia was significantly higher in patients with confirmed AGT at FU-visit than in other groups. Mortality was higher in group 1 (11.9%) than in group 2 (2.1%; p = 0.034) and group 4 (2.9%; p = 0.009). Mortality rates between group 2 and 4 were similar (2.1% vs. 2.9%; p = 0.781). There was no significant difference in mortality between group 1 and group 3 (11.9% vs. 6.1%; p = 0.114). Mortality in group 3 was over two-fold higher than in group 4; however, this difference was statistically non-significant (6.1% vs. 2.9%; p = 0.247). Conclusions:Prognosis for patients with confirmed AGT was unfavourable; however, patients with AGT at discharge, in whom GS improved, had similar mortality to subjects with persistent NGT. The major clinical implication from this study is the finding that reassessment of GS by repeated oral glucose tolerance test has significant prognostic value and makes initial risk stratification performed at discharge more reliable.

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Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction

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.

Cited by 244 publications

References 23 publications

The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

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

Long-term prognosis is related to mid-term changes of glucometabolic status in patients with acute myocardial infarction treated invasively

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