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

Abstract

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...

Importance of Investigating Mild Hyperglycaemia Using Oral Glucose Tolerance Test in the Setting of Acute Coronary Syndrome: Prospective Investigational Study

“…These findings are consistent with a previous study (Wallander et al 2008) which included 61 patients (62% male; mean age 64±12.5 years), of whom 70% were White European and 30% were South Asian. Mean plasma glucose level on admission was 6.9±1.7 (range 5.…”

Implications of abnormal glucose metabolism in patients with coronary artery disease

“…Ninety-three percent of all patients with T2DM at hospital discharge were still classified with IGT or T2DM after 12 months of follow-up. 13 Abnormal glucose metabolism in patients with coronary artery disease Guidelines for managing patients with diabetes, prediabetes and cardiovascular disease state that all patients with these conditions should be tested if their glucometabolic condition is not already known. 14 Routine use of OGTTs in the cardiology setting is a simple, cost-effective approach that has the potential to improve the detection and management of glucometabolic abnormalities significantly in patients with cardiovascular disease.…”

Postmeal Glucose Compared to Oral Glucose Tolerance in Non-Diabetic Patients with Acute Myocardial Infarction

“…Acute stressinduced hyperglycemia is also supported by a study where 61% of non-diabetic patients with acute stroke had AGT at discharge, but after re-investigation at three months more than half of them were categorized as having NGT [28]. By contrast, in the study by Wallander et al [29], 93% of newly detected diabetic patients evaluated by OGTT during acute myocardial infarction at discharge still had AGT after 3 and 12 months. This is supported by our finding that OGTT2h did not change within the one-month spectrum of sampling.…”