Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study.
Level 3 - non-randomized controlled study
Prospective observational cohort study
PubMed 12090978 · doi:10.1016/S0140-6736(02)09089-X
What was done
Prospective cohort study of 181 consecutive patients admitted to coronary care units at two Swedish hospitals with acute myocardial infarction (AMI), no known diabetes history, and admission blood glucose < 11.1 mmol/L. Investigators monitored in-hospital blood glucose and performed standardized 75 g oral glucose tolerance tests (OGTT) at hospital discharge and again at 3 months follow-up.
What was found
Mean patient age was 63.5 years (SD 9) and mean admission blood glucose was 6.5 mmol/L (SD 1.4). Mean 2-hour postload glucose was 9.2 mmol/L (SD 2.9) at discharge and 9.0 mmol/L (SD 3.0) at 3 months. At discharge, 58 of 164 patients (35%, 95% CI 28–43%) had impaired glucose tolerance (IGT) and 51 of 164 (31%, 95% CI 24–38%) had undiagnosed diabetes. At 3 months, 58 of 144 patients (40%, 95% CI 32–48%) had IGT and 36 of 144 (25%, 95% CI 18–32%) had undiagnosed diabetes. Independent predictors of abnormal glucose tolerance at 3 months were admission HbA1c (p=0.024) and day 4 fasting blood glucose (p=0.044).
Why it matters
This study demonstrates that abnormal glucose regulation is highly prevalent in AMI patients without known diabetes and persists beyond the acute stress phase, showing that early OGTT can identify high-risk individuals.
Limits
The sample size was modest and restricted to two Swedish centers, limiting generalizability. There was loss to follow-up between enrollment (n=181), discharge testing (n=164), and 3-month testing (n=144). Long-term clinical cardiovascular outcomes and therapeutic interventions were not evaluated.
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