Abnormal glucose tolerance – a common risk factor in patients with acute myocardial infarction in comparison with population‐based controls

Bartnik, Małgorzata; Malmberg, Klas; Hamsten, Anders; Efendić, Suad; Norhammar, Anna; Silveira, Angela; Tenerz, Åke; Öhrvik, John; Rydén, Lars

doi:10.1111/j.1365-2796.2004.01371.x

Cited by 89 publications

(68 citation statements)

References 48 publications

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“…In previous analyses of the present patient material, we have seen that patients with AMI and AGT did not differ as much as would have been expected in insulin resistance compared with patients with NGT and compared with controls. Furthermore, large differences in proinsulin between patients and controls were found [14]. Therefore, we wanted to further investigate the pathogenesis of AGT by estimating beta cell function in this specific patient group.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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%

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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“…A detailed description of the patients and control subjects from the Glucose Tolerance in patients with Acute Myocardial Infarction (GAMI) study has been presented elsewhere [3,16]. Patients admitted for AMI were included if they fulfilled the following criteria: no previously known diabetes, baseline capillary blood glucose <11.1 mmol/l, serum creatinine <200 μmol/l and age ≤80 years.…”

Section: Methodsmentioning

confidence: 99%

“…A control group, described in detail elsewhere [16], was recruited by the use of local population registries that included all inhabitants of the two counties corresponding to the catchment areas of the participating hospitals. Five subjects matched for age and sex were randomly chosen as potential control subjects for each patient.…”

Section: Methodsmentioning

confidence: 99%

Insulin-like growth factor I: a predictor of long-term glucose abnormalities in patients with acute myocardial infarction

et al. 2006

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Aims/hypothesis Low levels of IGF-I are associated with increased risk of cardiovascular disease and type 2 diabetes. The aim of this study was to investigate the IGF-I system in patients with acute myocardial infarction (AMI) without previously known diabetes. Materials and methods One hundred and sixty-eight AMI patients were classified before hospital discharge by means of an OGTT as having NGT, IGT or newly detected type 2 diabetes. Age-and sex-matched subjects from the background population (n=185) served as the control group. The associations between fasting levels of IGF-I and IGF binding proteins 1 and 3 (IGFBP-1, IGFBP-3) and glucose metabolism during a follow-up period of 12 months were studied.

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“…Blood glucose was analyzed immediately in capillary whole blood by means of the HemoCue procedure (photometer; HemoCue, Á ngelholm, Sweden). A detailed description of laboratory methods has been presented elsewhere (1,10). Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated in fasting condition according to Matthews et al (11).…”

Section: Research Design Andmentioning

confidence: 99%

Oral Glucose Tolerance Test: A Reliable Tool for Early Detection of Glucose Abnormalities in Patients With Acute Myocardial Infarction in Clinical Practice

Wallander

Malmberg²,

Norhammar³

et al. 2008

Diabetes Care

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OBJECTIVE -Previously undetected glucose abnormalities are common in patients with acute myocardial infarction (AMI). We evaluated long-term reliability of early glucometabolic classification of patients with AMI by repeated oral glucose tolerance tests (OGTTs). RESEARCH DESIGN AND METHODS-A glucometabolic OGTT-based classification was obtained in 122 patients by measuring capillary whole-blood glucose. The classification was performed on three occasions, before hospital discharge and 3 and 12 months thereafter.RESULTS -At discharge, 34, 31, and 34% were classified as having normal glucose tolerance, impaired glucose tolerance (IGT), or type 2 diabetes, respectively, and 93% of all patients with type 2 diabetes were still classified with type 2 diabetes (n ϭ 27) or IGT (n ϭ 12) after 12 months. The agreements between the OGTTs at discharge and 3 and 12 months were ϭ 0.35, P Ͻ 0.001, and ϭ 0.43, P Ͻ 0.001, respectively. CONCLUSIONS -The outcome of an OGTT performed in AMI patients at hospital discharge reliably informs on long-term glucometabolic state. Diabetes Care 31:36-38, 2008I n recent years, focus has been devoted to the high prevalence of previously undiagnosed glucose abnormalities in patients with acute myocardial infarctions (AMIs) as reported by the GAMI (Glucose tolerance in Acute Myocardial Infarction [1]) Study and subsequently confirmed by the Euro and China Heart Surveys (2,3). These findings attracted further attention when it recently became evident that postinfarction patients with newly detected disturbed glucose metabolism are at an increased risk for cardiovascular morbidity and mortality (4,5), emphasizing the importance of diagnosing these patients at an early stage.Classification of glucose abnormalities should, according to the World Health Organization (WHO) (6), be based on fasting and postload plasma glucose obtained by a standardized oral glucose tolerance test (OGTT), while the most recent American Diabetes Association (ADA) criteria (7) includes fasting blood glucose only. The latter method will, however, identify only about onethird of individuals defined with newly detected diabetes by means of an OGTT (1,8,9).This analysis from the GAMI Study aimed at investigating the long-term reliability of early classification of glucose abnormalities using OGTT in patients with AMI without previously known type 2 diabetes. RESEARCH DESIGN ANDMETHODS -A detailed description of the GAMI Study has been presented elsewhere (1). The inclusion criteria were suspected AMI, no previously known diabetes, baseline capillary blood glucose Ͻ11.1 mmol/l, serum creatinine Ͻ200 mol/l, and age Յ80 years. A total of 181 participants were enrolled, of whom 168 were characterized on discharge after an OGTT as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or type 2 diabetes. The present report is based on the 122 patients, who at all occasions during follow-up (discharge and 3 and 12 months) could be reclassified into the three groups.A standardized OGTT (75-g glucose in 200 ml wate...

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Abnormal glucose tolerance – a common risk factor in patients with acute myocardial infarction in comparison with population‐based controls

Cited by 89 publications

References 48 publications

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

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

Insulin-like growth factor I: a predictor of long-term glucose abnormalities in patients with acute myocardial infarction

Oral Glucose Tolerance Test: A Reliable Tool for Early Detection of Glucose Abnormalities in Patients With Acute Myocardial Infarction in Clinical Practice

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