Acute myocardial infarction admission glucose level predicts mortality

Main Category: Diabetes
Article Date: 18 May 2004 - 0:00 PDT

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Blood glucose levels upon hospital admission for acute myocardial infarction (AMI) independently predict long-term mortality in patients both with and without diabetes, Dutch research reveals.

The study, published in the Archives of Internal Medicine, showed that individuals with unknown diabetes and an admission glucose level within the diabetic range after AMI were at similar risk of death to patients with established diabetes.

Ischa Stranders (VU University Medical Center, Amsterdam) and colleagues believe that their findings could help to identify individuals at high long-term risk of mortality, particularly among those with unknown diabetes.

Although high blood glucose levels are common in patients admitted to hospital with AMI, and are associated with an increased risk of death in both diabetic and nondiabetic subjects, most studies have focused only on short-term prognosis.

In the current investigation, Stranders and team examined its effect in 846 patients who were tracked for a maximum of 93 months. Of the participants, 109 had known diabetes, and 737 did not.

Over a median of 50 months' follow-up, 28.2% of nondiabetic patients and 43.1% of diabetic patients died (p=0.002). The researchers found that each 18 mg/dl increase in glucose level increased the risk of death by 4% in nondiabetics and by 5% in diabetics (both p<0.05).

Among the 101 nondiabetic individuals who had admission blood glucose levels of 200 mg/dl or more - within the range for diabetes - mortality was comparable to that of those with established diabetes, at 42.6% versus 43.1%.

Stranders and team suggest that an AMI may unmask pre-existing insulin resistance and pancreatic beta-cell dysfunction, and could identify a cluster of cardiovascular risk factors associated with dysglycemia.

They add that the elevated risk with high admission glucose may be due to undiagnosed insulin resistance or metabolic syndrome, compatible with pre-diabetes or actual diabetes.

Highlighting that up to 50% of subjects in the general population have undiagnosed Type 2 diabetes, the team suggests: "Admission blood glucose level after AMI may be an important tool for risk stratification at follow-up and a potential point of impact for therapeutic measures."

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