EXAMINING GLUCOSE METABOLISM IN INDIVIDUALS WITH ACUTE MYOCARDIAL INFARCTION WHO HAD NOT PREVIOUSLY BEEN DIAGNOSED WITH DIABETES MELLITUS A PROSPECTIVE STUDY

Main Article Content

Muhammad Hussain Afridi
Cheragh Hussain
Akbar Shah
Shaista Kawanl
Nizamuddin

Keywords

Glucose metabolism, Myocardial infarction, Diabetes mellitus, Abnormalities, Early detection

Abstract

Background: Whether or not a patient has been diagnosed with diabetes mellitus, their metabolic condition upon hospital admission is a significant risk factor for long-term mortality in patients who have had an acute myocardial infarction.


Objectives: Our objectives were to determine the frequency of abnormal glucose metabolism in myocardial infarction patients who did not have a diagnosis of diabetes and to determine if these abnormalities might be detected early in the myocardial infarction.


Study Design:  A Prospective Study


Place and duration of study: Department of Diabetes & Endocrinology & Cardiology HMC Hospital Peshawar from 1st Jan 2021 to 1st july- 2022


 


Methods: We conducted a prospective study in which we included 100 consecutive acute myocardial infarction patients hospitalized in the coronary care units of two Swedish hospitals. The patients did not have a diagnosis of diabetes and had blood glucose levels below 11.1 mmol/L. During the hospital stay, we monitored glucose levels and performed standardized oral glucose tolerance tests using 75 g of glucose upon discharge and then again after three months.


Results:  Our cohort's mean age was 65.06 years (SD 09), and upon admission, its mean blood glucose level was 06.05 mmol/L (01.03). At hospital discharge, the mean 02-h post-load blood glucose concentration was 09.01 mmol/L (02.08), and three months later, it was 08.0 mmol/L (02.1). At discharge and after three months, respectively, 34 of 100 (34%, 96% CI 26-41) and 38 of 100 (38%, 30-43) patients had impaired glucose tolerance; 32 of 100 (32%, 22-35) and 23 of 100 (23%, 22-28) patients had previously undetected diabetes mellitus. Concentrations of HbA(01c) at admission (p=0.022) and fasting blood glucose concentrations on day 06 (p=0.042) were independent predictors of impaired glucose tolerance at three months.


 


Conclusion :


This future study emphasizes how common aberrant glucose metabolism is in individuals who have had an acute myocardial infarction but have not previously been diagnosed with diabetes. Reducing the risk of long-term mortality requires early diagnosis and care of these disorders. Future glucose tolerance problems may be predicted using variables such as fasting blood glucose concentrations and HbA1c levels.

Abstract 49 | PDF Downloads 22

References

1. Norhammar, A., Tenerz, Å., Nilsson, G., Hamsten, A., Efendíc, S., Rydén, L., & Malmberg, K. (2002). Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: A prospective study. The Lancet, 359(9324), 2140-2144.

2. Capes, S. E., Hunt, D., Malmberg, K., Gerstein, H. C. (2000). Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. The Lancet, 355(9206), 773-778.


3. Timmer, J. R., Ottervanger, J. P., Bilo, H. J., Gosselink, A. T., Dambrink, J. H., & Miedema, K. (2004). Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. American Heart Journal, 148(3), 399-404.

4. Norhammar, A., Tenerz, Å., Nilsson, G., Hamsten, A., Efendíc, S., Rydén, L., & Malmberg, K. (2002). Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: A prospective study. The Lancet, 359(9324), 2140-2144.


5. Capes, S. E., Hunt, D., Malmberg, K., Gerstein, H. C. (2000). Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. The Lancet, 355(9206), 773-778.
6. Timmer, J. R., Ottervanger, J. P., Bilo, H. J., Gosselink, A. T., Dambrink, J. H., & Miedema, K. (2004). Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. American Heart Journal, 148(3), 399-404.

7. Esdaile H, Hill N, Mayet J, Oliver N. Glycaemic control in people with diabetes following acute myocardial infarction. Diabetes Research and Clinical Practice. 2023 Mar 29:110644.


8. Fu R, Cui K, Yang J, Xu H, Yin D, Song W, Wang H, Zhu C, Feng L, Wang Z, Wang Q. Fasting stress hyperglycemia ratio and in-hospital mortality after acute myocardial infarction in patients with different glucose metabolism status: Results from China acute myocardial infarction registry. Diabetes Research and Clinical Practice. 2023 Feb 1;196:110241.

9. Kwon O, Myong JP, Lee Y, Choi YJ, Yi JE, Seo SM, Jang SW, Kim PJ, Lee JM. Sodium‐Glucose Cotransporter‐2 Inhibitors After Acute Myocardial Infarction in Patients With Type 2 Diabetes: A Population‐Based Investigation. Journal of the American Heart Association. 2023 Jul 18;12(14):e027824.


10. Jyotsna FN, Ahmed A, Kumar K, Kaur P, Chaudhary MH, Kumar S, Khan E, Khanam B, Shah SU, Varrassi G, Khatri M. Exploring the complex connection between diabetes and cardiovascular disease: analyzing approaches to mitigate cardiovascular risk in patients with diabetes. Cureus. 2023 Aug 21;15(8).

11. Chin Y, Lim J, Kong G, Ng CH, Goh R, Muthiah M, Mehta A, Chong B, Lin C, Chan KE, Kong W. Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction. Diabetes, Obesity, and Metabolism. 2023 Apr;25(4):1032-44.


12. Khaleghi S, Bayani M, Ziaei N, Salehiomran M, Khafri S. The glycosylated hemoglobin level and the severity of cardiovascular involvement in patients with the first episode of acute coronary syndrome. Caspian Journal of Internal Medicine. 2024 Jan 10;15(1):46-52.

13. Razaghizad A, Sharma A, Ni J, Ferreira JP, White WB, Mehta CR, Bakris GL, Zannad F. External validation and extension of the TIMI risk score for heart failure in diabetes for patients with recent acute coronary syndrome: an analysis of the EXAMINE trial. Diabetes, Obesity, and Metabolism. 2023 Jan;25(1):229-37.

14. Duan W, Shi R, Yang F, Zhou Z, Wang L, Huang Z, Zang S. FSTL3 partially mediates the association of increased nonalcoholic fatty liver disease fibrosis risk with acute myocardial infarction in patients with type 2 diabetes mellitus. Cardiovascular Diabetology. 2023 Oct 30;22(1):297.

15. Ritsinger V, Hagström E, Hambraeus K, James S, Jernberg T, Lagerqvist B, Leosdottir M, Lundman P, Pernow J, Östlund O, Norhammar A. Design and rationale of the myocardial infarction and new treatment with metformin study (MIMET)-Study protocol for a registry-based randomized clinical trial. Journal of Diabetes and its Complications. 2023 Oct 1;37(10):108599.

16. Terlecki M, Kocowska-Trytko M, Pavlinec C, Ostrowska A, Lis P, Bednarski A, Wojciechowska W, Stolarz-Skrzypek K, Rajzer M. The role of stress hyperglycemia and hyperlactatemia in non-diabetic patients with myocardial infarction treated with percutaneous coronary intervention. Cardiology Journal. 2023 Jun 20.