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- July 20, 2008 |
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CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"Dysglycemia in Acute Coronary Syndrome Patients"Dr. Jacob Ilany (biography)
English - 2005-04-15 - 32 minutes
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Summary :
In order to assess the frequency, characteristics and pathogenesis of glucose metabolism abnormalities in patients with acute coronary event, we performed OGTT to patients that were admitted to our intensive coronary unit. We included all patients with suspected coronary event without prior diagnosis of diabetes mellitus at age 20 to 80 years. Glucose, insulin and c-peptide level before and 120 minutes after loading of 75 grams of glucose were measured. The test was performed between the second and 4th day of admission.
Results: From January to September 2003, 278 patients were admitted to the coronary unit. Out of them, 128 underwent OGTT. Seventy five patients had prior diagnosis of diabetes. In the other 75 patients the test was not performed due to age over 80 years, refusal, or clinical situation that did not allow the test.
Of those who had the OGTT, 6 patients (5%) had diabetes based on fasting glucose level. Thirty three (26%) were found to have diabetes by OGTT, while 45 (35%) had impaired glucose tolerance. Eleven patients (9%) had impaired fasting glucose (≥100mg/dl). Only 29 patients (23%) had normal glucose metabolism.
Using HOMA and Quicki calculations, patients with high fasting glucose had insulin resistance compared to patients with normal glucose metabolism. Diabetic patients had beta-cell abnormality.
Conclusion: the majority of patients with acute coronary event had abnormal glucose metabolism. Dysglycemia was less common in younger patients. The subgroup of patients with impaired fasting glucose who had coronary event were characterized by more pronounce insulin resistance.
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The pathogenesis of dysglycemia
- Prevalence of dysglycemia
- The pathogenesis of the prediabetes condition
- The contribution of acute stress to dysglycemia
Bibliographic references :
Anna Norhammar, Åke Tenerz, Göran Nilsson, Anders Hamsten, Suad Efendíc, Lars Rydén and Klas MalmbergGlucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study The Lancet, Volume 359, Issue 9324, 22 June 2002, Pages 2140-2144
Frank B. Hu, Meir J. Stampfer, Steven M. Haffner, Caren G. Solomon, Walter C. Willett, and JoAnn E. MansonElevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes Diabetes Care 25: 1129-1134.
K. M. Choi, K. W. Lee, S. G. Kim, N. H. Kim, C. G. Park, H. S. Seo, D. J. Oh, D. S. Choi, and S. H. BaikInflammation, Insulin Resistance, and Glucose Intolerance in Acute Myocardial Infarction Patients without a Previous Diagnosis of Diabetes MellitusJ. Clin. Endocrinol. Metab., Jan 2005; 90: 175 - 180.
Åke Tenerz, Anna Norhammar, Angela Silveira, Anders Hamsten, Göran Nilsson, Lars Rydén, and Klas MalmbergDiabetes, Insulin Resistance, and the Metabolic Syndrome in Patients With Acute Myocardial Infarction Without Previously Known DiabetesDiabetes Care 26: 2770-2776.
M Tominaga, H Eguchi, H Manaka, K Igarashi, T Kato, and A SekikawaImpaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes StudyDiabetes Care 22: 920-924
J. Kuhl, A. Hilding, C. G. Östenson, V. Grill, S. Efendic and P. BåvenholmCharacterisation of subjects with early abnormalities of glucose tolerance in the Stockholm Diabetes Prevention Programme: the impact of sex and type 2 diabetes heredity Diabetologia: Volume 48, Number 1 pg 35-40
Markolf Hanefeld, Carsta Koehler, Katja Fuecker, Elena Henkel, Frank Schaper, and Theodora Temelkova-KurktschievInsulin Secretion and Insulin Sensitivity Pattern Is Different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose: The Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes Study Diabetes Care 26: 868-874.
Andreas Festa, Ralph D’Agostino, Jr., Anthony J.G. Hanley, Andrew J. Karter, Mohammed F. Saad, and Steven M. HaffnerDifferences in Insulin Resistance in Nondiabetic Subjects With Isolated Impaired Glucose Tolerance or Isolated Impaired Fasting GlucoseDiabetes 53: 1549-1555.
Malgorzata Bartnik, Lars Rydén, Roberto Ferrari, Klas Malmberg, Kalevi Pyörälä, Maarten Simoons, Eberhard Standl, Jordi Soler-Soler, John Öhrvik on behalf of the Euro Heart Survey InvestigatorsThe prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: The Euro Heart Survey on diabetes and the heartEur. Heart J., November 2004; 25: 1880 - 1890.
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