Temporal change in glucose tolerance in non-ST-elevation myocardial infarction

• Published in: Diabetes research and clinical practice Vol. 82; no. 3; pp. 310 - 316
• Main Authors: Srinivas-Shankar, U., Somauroo, J.D., Delduca, A.-M., Jordan, T.S., Bowles, S.A., Rutter, M.K.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.12.2008
• Subjects: Acute coronary syndrome; Aged; Blood Glucose - analysis; Diabetes; Endocrinology & Metabolism; Glucose Intolerance - etiology; Glucose tolerance; Glucose Tolerance Test; Humans; Hyperglycemia - etiology; Middle Aged; Myocardial Infarction - complications; Non-ST-elevation myocardial infarction; Prevalence; Risk factors; Time Factors; NSTEMI; CRP; 2hrPG; NSTE-ACS; DM; IFG; UA; AGT; Risk factors; Glucose tolerance; ACS; HbA 1c; IGT; STEMI; Non-ST-elevation myocardial infarction; TnT; Diabetes; FPG; OGTT; Acute coronary syndrome; BMI; high sensitivity C-reactive protein; ST-elevation myocardial infarction; oral glucose tolerance test; impaired glucose tolerance; 2-h plasma glucose; glycosylated haemoglobin; non-ST-elevation myocardial infarction; troponin T; acute coronary syndrome; impaired fasting glucose; abnormal glucose tolerance; body mass index; non-ST-elevation acute coronary syndrome; unstable angina; fasting plasma glucose; diabetes
• ISSN: 0168-8227; 1872-8227; 1872-8227
• DOI: 10.1016/j.diabres.2008.08.016

We assessed the prevalence and 3-month change in glucose tolerance status in consecutive non-ST-elevation myocardial infarction (NSTEMI; European Society of Cardiology 2007 definition) patients ( N = 49; mean (S.D.) age 65 (11) years) admitted to a coronary care unit, without known diabetes. These patients underwent an oral glucose tolerance test (OGTT) 36-hour (median, IQR: 18–72) after admission and at 3 months. Undiagnosed abnormal glucose tolerance (AGT: impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or new diabetes) was common (61% at admission and 41% at 3 months, p < 0.05) and the majority (∼3/4) had IGT. Glucose tolerance status improved in a higher proportion of patients than it worsened (31% vs. 8%, p = 0.04). At 3 months, fasting glucose was unchanged but 2-hour OGTT glucose was lower (mean (S.D.): 8.5 (2.7) mmol/L vs. 7.7 (2.7) mmol/L, p = 0.004). ‘Stress hyperglycaemia’ could explain higher admission glucose levels and this raises the question about the optimal timing of OGTT in relation to myocardial infarction. Newly diagnosed diabetes was present in ∼10% of patients and this was not reliably detected by fasting plasma glucose. In NSTEMI patients OGTT is the only reliable strategy to identify subjects with IGT and diabetes.