High incidence of abnormal glucose metabolism in acute coronary syndrome patients at a moderate altitude: A sub-Himalayan study

Abstract

Background:Abnormal glucose metabolic status at admission is an important marker of future cardiovascular events and long-term mortality after acute coronary syndrome (ACS), whether or not they are known diabetics.Objective:The aims were to study the prevalence of abnormal glucose metabolism in ACS patients and to compare the different methods of diagnosing diabetes in ACS patients.Methods:We did a prospective study. About 250 consecutive nondiabetic patients (200 men and 50 women) with ACS admitted to a tertiary care institute of Himachal Pradesh in 1 year were enrolled. Admission plasma glucose, next morning fasting plasma glucose (FPG), A1C, and a standardized 75-g oral glucose tolerance test (OGTT) 72 h after admission were done. Glucose metabolism was categorized as normal glucose metabolism, impaired glucose metabolism (impaired fasting glucose or impaired glucose tolerance [IGT]), and diabetes. Diabetes was arbitrarily classified further as undiagnosed (HBA1c ≥6.5%) or possibly stress diabetes (HBA1c <6.5%). A repeat OGTT after 3 months in objects with IGT and stress hyperglycemia at a time of admission was done.Results:The mean age was 54 ± 12.46 years. The mean plasma glucose at admission was 124 ± 53.96 mg/dL, and the mean FPG was 102 ± 27.07 mg/dL. The mean 2-h postglucose load concentration was 159.5 ± 56.58 mg/dL. At baseline, 95 (38%) had normal glucose metabolism, 95 (38%) had impaired glucose metabolism (IGT and or IGT) and 60 (24%) had diabetes; 48 (19.2%) were undiagnosed diabetes and 12 (4.8%) had stress hyperglycemia. At follow up 58.66% and 55.55% of patients with impaired glucose tolerance and stress hyperglycemia continued to have impaired glucose tolerance respectively. About 75 gm OGTT has highest sensitivity and specificity to diagnose diabetes, whereas A1C most specific to rule out stress hyperglycemia.Conclusions:In this small hilly state of India, abnormal glucose metabolism (previously undiagnosed diabetes and IGT) is common in patients admitted with ACS. Abnormal glucometabolic status can be detected early in the postadmission period. Our results further suggest that 75-g OGTT remained the gold standard test to detect diabetes and could be used before discharge to diagnose diabetes.

Significance of day-to-day glucose variability in heart failure patients after acute coronary syndrome

“…These results suggest that CGM may provide indications of diabetes and glucose intolerance in some patients who were considered normal using previous diagnostic methods. Previous reports have shown that when oral glucose tolerance testing (OGTT) was performed on patients admitted with ACS, 24% were diagnosed as diabetic, 38% as impaired glucose tolerance, and the remaining 38% as normal 12,13 . Day-to-day assessment of blood glucose using CGM could identify patients with blood glucose variations beyond daily glucose variability.…”

Significance of day-to-day glucose variability in patients after acute coronary syndrome

“…These results suggest that CGM may provide indications of diabetes and glucose intolerance in some patients who were considered normal using previous diagnostic methods. Previous reports have shown that when oral glucose tolerance testing (OGTT) was performed on patients admitted with ACS, 24% were diagnosed as diabetic, 38% as impaired glucose tolerance, and the remaining 38% as normal [ 13 , 14 ]. Day-to-day assessment of blood glucose using CGM could identify patients with blood glucose variations beyond daily glucose variability.…”

The Outcome of Patients with Acute Coronary Syndrome Those Associated with Impaired Glucose Tolerance in AL-Nasiriya Governorate / Iraq

“…In China Heart Survey aimed at characterizing the glucometabolic state of patients with CAD with no history of diabetes revealed 32.6% of those patients had isolated IGT [37]. Jitender Mokta, et al study showed a high prevalence of IGT (62%) in patients admitted with ACS in mountainous state on India [38].…”