Should oral glucose tolerance test be a routine examination after a myocardial infarction?
Introduction
Diabetes mellitus (DM) is a well-known risk factor for cardiovascular mortality [1], [2]. There are also studies indicating that people with prediabetic conditions, such as impaired glucose tolerance (IGT), have an increased risk for cardiovascular disease [3], [4]. The growing knowledge about the close relationship between DM and cardiovascular morbidity and intervention studies showing that the poor prognosis in both type I and type II DM can be improved [5], [6], [7], has put focus on the relevance of identification of patients with IGT and DM. This is especially important in patients who have suffered from a myocardial infarction, since the combination of coronary disease and DM is deleterious [8].
Recently, a high prevalence of undiagnosed diabetes and IGT was reported in a study of 181 consecutive patients admitted to a coronary care unit with acute myocardial infarction [9]. In that study standardised oral glucose tolerance tests were performed at discharge and again 3 months later.
The aim of this study was to assess the prevalence of DM and IGT in patients discharged from the CCU without known diagnosis DM after a myocardial infarction.
Section snippets
Subjects
One hundred and ten patients, men and women aged between 31 and 80 years with a previous acute myocardial infarction were included. The inclusion criterion was hospital-diagnosed myocardial infarction occurring 1–12 months before the examination. A majority of the patients were recruited at the step-down unit 2–3 days after the myocardial infarction. The examinations of this study were performed 1–12 months after the index event. The exclusion criterion was known DM. The patients were recruited
Results
Baseline characteristics of all individuals enrolled are shown in Table 1. Almost 75% of study group were male and 25% were female. Forty-nine percent of patient had undergone PTCA and 20% CABG.
Table 2 shows the prevalence of glucose abnormalities among the examined patients. The 2-h PG was elevated in 42 (38%) of the 110 patients. IGT was observed in 29 (26%) patients and DM in 13 (12%) patients. FPG was ≥7.0 mmol/l in five subjects and between 6.1 and 6.9 mmol/l in nine subjects.
FPG was ≥7.0
Discussion
In this study the prevalence of DM and IGT in patients discharged from the CCU without the known DM after a myocardial infarction was 38%. Twelve percent had DM and 26% IGT.
This observation was based on the result of an oral glucose tolerance test. We also examined whether a fasting glucose could identify these patients, making the OGTT unnecessary. The revised recommendation from WHO and American Diabetes Association (ADA) [12] have emphasised the use of the fasting glucose diagnostic criteria
Acknowledgements
The study has been supported by grants from Karolinska Institute and the Swedish Medical Society.
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Cited by (13)
Poor reproducibility of the oral glucose tolerance test in the diagnosis of diabetes during percutaneous coronary intervention
2010, International Journal of CardiologyCitation Excerpt :The de novo diagnosis of carbohydrate intolerance with the OGTT was an important prognostic factor in an unselected sample of patients admitted with a main diagnosis of acute myocardial infarction [12]. These data led to the recent European guidelines [6] highlighting the indication for an OGTT in all patients with cardiovascular disease (Class I indication, level of evidence B), although it was suggested previously [13]. Nevertheless, controversy still exists concerning the ideal diagnostic tool for previously unknown DM.
Myocardial infarction and incidence of type 2 diabetes mellitus. Is admission blood glucose an independent predictor for future type 2 diabetes mellitus?
2010, American Heart JournalCitation Excerpt :In addition, although an OGTT is certainly the most sensitive test for diagnosing diabetes, there is concern about its reproducibility.23 Prior studies found that fasting plasma glucose and HbA1c are good measures to predict abnormal glucose tolerance.24,25 The present study further showed that there is a continued progression to diabetes over time, and even if the initial follow-up result would be normal, individuals are still at risk of diabetes in the future.
Temporal change in glucose tolerance in non-ST-elevation myocardial infarction
2008, Diabetes Research and Clinical PracticeCitation Excerpt :However, in the Euro Heart Survey adverse outcomes at 1 year were related to newly diagnosed diabetes, but not to IFG or IGT [20]. Prior cross-sectional studies have been somewhat limited: (a) only one study from China [21] has assessed AGT prevalence in NSTEMI; (b) only two studies in unselected myocardial infarction patients have assessed temporal changes in AGT by serial OGTT [5,8,22]; (c) several studies have methodological issues including retrospective design [11,23], inclusion of patients with known diabetes [14], incomplete OGTT testing [6,8,9,11,23], differences in the classification of ACS [9,10,13,21], or diabetes [23], differences in the timing of OGTT in relation to the ACS event [11–14,21,23], and high rates of revascularization [14]. The aims of this study were to describe the prevalence and temporal change in glucose tolerance in NSTEMI patients without known DM.
Conventional treatment after myocardial infarction in routine clinical practice results in regression of left common carotid intima-media thickness
2014, Clinical Physiology and Functional Imaging