Postload glucose spike but not fasting glucose determines prognosis after myocardial infarction in patients without known or newly diagnosed diabetes

Abstract

Background: The effect of postload glucose spikes (PGS), the difference between 2 hour post-load plasma glucose (2hPLPG) and fasting plasma glucose (FPG), on post-myocardial infarction (post-MI) prognosis in nondiabetic patients is unexplored. Methods: This is a retrospective cohort analysis of 847 nondiabetic post-MI survivors who underwent a predischarge oral glucose tolerance test (median PGS: 2.4 mmol/L). Patients were divided into the unmatched groups 1 and 2 (PGS ≤ and > 2.4 mmol/L) and the propensity score-matched groups 1M and 2M (355 pairs assembled from the overall cohort), and these groups were compared. Major adverse cardiac events (MACE: death and nonfatal reinfarction) were recorded during follow-up (median: 3.4 years). Event-free survival was compared by the Kaplan-Meier method. Multivariate Cox proportional hazards regression determined the predictors of MACE. C-statistics (change in area under the curve, δAUC), continuous net reclassification improvement (NRI >0), and integrated discrimination improvement (IDI) were used to compare models. Results: The number of MACE was higher in groups 2 (27.3% vs 14.2%, P < .001) and 2M (24.5% vs 15.5%, P < .001). Event-free survival was worse in groups 2 (hazard ratio [HR] 2.

Increased Two-Hour Post-Load Plasma Glucose Fluctuation Corresponds with Worse Clinical Prognoses among Acute Ischemic Stroke Patients without a History of Diabetes Mellitus

“…However, this was contradicted in another study where elevated 2hPG below the threshold of diabetes, but not FPG, was associated with increased likelihood of cardiovascular diseases, including ischemic stroke [36]. As a result of these contradictory findings, we focused on the fluctuation in glucose levels itself, in the form of 2hPG-FPG, which has previously been found to be a better predictor of poor prognoses, such as death and non-fatal reinfarction, than 2hPG alone [16]. Our results were in line with those observations, in which we determined that 2hPG-FPG was independently associated with poorer 1-year clinical prognoses after AIS, independent of 2hPG, FPG, and DM.…”

“…Increased fluctuations between fasting and 2 h post-load glucose states were strongly associated with increased estimated glomerular filtration rate and an increased risk of glomerular hyperfiltration in newly diagnosed diabetic patients with HbA1c <7% [18]. 2hPG-FPG has also been found to be more predictive of poorer prognoses, such as death and non-fatal reinfarction, in a cohort of non-diabetic patients after myocardial infarction, compared to 2hPG alone [16]. However, the precise relationship between 2hPG-FPG and clinical prognosis in AIS patients is still largely unknown.…”

“…In fact, 2-h post-load glucose (2hPG) levels measured using OGTT were strongly correlated with glucose fluctuations, as it most commonly occurs after meals, providing a simpler measuring method for these fluctuations than continuous glucose monitoring [15]. Furthermore, 2-h post-load minus fasting plasma glucose (2hPG-FPG) was an even more sensitive measurement of glucose fluctuation [16]. The Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study shows that 2hPG-FPG had a significant effect on poorer prognoses in the non-diabetic population, with an increase in patient deaths with increasing 2hPG-FPG values [17].…”

Postprandial Asymptomatic Glycemic Fluctuations after Gastrectomy for Gastric Cancer Using Continuous Glucose Monitoring Device

“…In addition, postprandial glucose spikes have recently been demonstrated in healthy subjects without conditions of impaired glucose tolerance, such as diabetes mellitus [ 23 ]. These spikes were also associated with the induction of endothelial dysfunction and oxidative stress, resulting in a risk of arteriosclerotic diseases, such as myocardial infarction [ 24 25 26 27 ]. Considering that marked postprandial glucose spikes were more commonly observed in TG-RY and DG-RY than in the other two procedures, R-Y reconstruction, which is a non-physiological reconstructive procedure in that food does not pass through the duodenum, might adversely influence postprandial asymptomatic glucose fluctuations, while the other procedures have relatively little impact.…”