Newly Diagnosed Diabetes and Stress Glycaemia and Its’ Association with Acute Coronary Syndrome
DOI:
https://doi.org/10.3889/oamjms.2015.103Keywords:
diabetes mellitus, stress glycaemya, hemoglobin A1C, acute coronary syndrome, cardiac eventsAbstract
BACKGROUND: Diabetes is diagnosed in 10-20% of patients with acute coronary syndrome (ACS) not known to be diabetics. Elevated blood glucose is an independent risk factor for cardiac events, regardless of presence of diabetes.
AIM: Evaluating the prevalence of new-diagnosed DM among patients with ACS, and assessing the relationship between stress glycaemia and new diagnosed DM with in-hospital cardiac events.
METHODS: Prospective observational study, in patients with ACS, in whom we analyzed parameters of glycemic metabolism, clinical data, and in-hospital cardiac events. We comparatively analyzed patients according to the HgbA1C and known DM in five groups: non-DM (< 5.6%), new pre-DM (5.6-6.5%), new DM (≥ 6.5%), controlled (<7%) and uncontrolled (≥7%) known DM.
RESULTS: 150 patients, (93 male and 57 female) were included. Impaired glucose metabolism was detected in 44.5% of patients, 7.9% of whom were newly-diagnosed DM. The highest levels of stress glycaemia were found in new and uncontrolled known DM. The in-hospital event rate was 20.7%, the mortality rate 7.3%, being the highest in new diagnosed and uncontrolled known DM patients.
CONCLUSIONS: The prevalence of unknown DM was high among patients with ACS. Stress glycaemia and failure to achieve glycemic controlee, were an independent predictors of in-hospital cardiac events.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Gangopadhyay KK, Bantwal G, Talwalkar PG, Muruganathan A, Das AK. Consensus Evidence Based Recommendations For In-patient Management of Hyperglycemia in Non-critical Care Setting as per Indian Clinical Practice. Suplement to Journal of the Association of Physicians of India. 2004; 62:6-15.
Abdullatef WK, Al-Aqeedi RF, Dabdoob W, Hajar HA, Bener A, Gehani AA. Prevalence of Unrecognized Diabetes Mellitus in Patients admitted with Acute Coronary Syndrome. Angiology. 2013:64(1):26-30. DOI: https://doi.org/10.1177/0003319711434054
Mukherjee ЈЈ, Chatterjee ПС, Saikia Ðœ, Ðœuruganathan Ð, Das ÐК. Consensus Recommendations for the Management of Hyperglycemia in Critically Ill Patients in the Indian Setting. Special Issue on Consensus Statements on Insulin Therapy. J Assoc Physicians India. 2014;62(7 Suppl):16-25.
Gornik I, Vujaklija-Brajkovic A, Renar IP, Gasparovic VA. Prospective Observational Study of the Relationship of critically illness associated hyperglycemia in medical ICU patients and subsequent development of type 2 diabetes. Crit Care. 2010;14:R130. DOI: https://doi.org/10.1186/cc9101
Kosiborod M, Inzucchi SE, Spertus JA, et al. Elevated admission glucose and mortality in elderly patients hospitalized with heart failure. Circulation. 2009; 119:1899-907. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.821843 PMid:19332465 DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.821843
Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000; 355:773-78. http://dx.doi.org/10.1016/S0140-6736(99)08415-9 DOI: https://doi.org/10.1016/S0140-6736(99)08415-9
Capes SE, Hunt D, Malmberg K, Pathak P. Gerstein HC. 32: Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001; 32:2426-32. http://dx.doi.org/10.1161/hs1001.096194 PMid:11588337 DOI: https://doi.org/10.1161/hs1001.096194
Gardner LS, Nguyen-Pham S, Greenslade JH, Parsonage W, D'Emden M, Than M, Aldous S, Brown A, Cullen L. Admission Glycaemia and Its Association with Acute Coronary Syndrome in Emergency Department Patients with Chest Pain. Emerg Med J. 2015;32 (8):608-612. DOI: https://doi.org/10.1136/emermed-2014-204046
Chih S, McQuillan BM, Kaye J, Beilby JP, Hung J. Abnormal glucose regulation in an Australian acute coronary syndrome population: a prospective study. Diabetes Res Clin Pract. 2008;81(3):303-9. http://dx.doi.org/10.1016/j.diabres.2008.04.026 PMid:18565611 DOI: https://doi.org/10.1016/j.diabres.2008.04.026
Simon K, Szépvölgyi A, Dobó E, Szabó A. Role of blood glucose in prediction of cardiovascular risk. Orv Hetil. 2006;147(3):115-9.
2015 American Diabetes Association (ADA) Diabetes Guidelines Summary Recommendations from NDEI. Diabetes Care. 2015; 38 (supl 1):S1-S93. DOI: https://doi.org/10.2337/dc15-S001
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0
