Dynamics of carbohydrate metabolism in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus during 6 months of follow-up

Abstract

Annotation. Hyperglycemia complicates the course of acute myocardial infarction (AMI) and is associated with its unfavorable prognosis. The aim of the study was to analyze the dynamics of carbohydrate metabolism in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus during 6 months of follow-up. The study involved 120 patients: group 1 – patients with AMI with diabetes mellitus (DM) type 2 (n=70), group 2 – patients with AMI (n=50) and 20 people who made up the control group. All patients underwent general instrumental and clinical examinations. Statistical processing of the results was performed using the software package “Statistica 6.0” (USA) with calculation: M ± m, probability and level of reliability (p) for comparison of samples. The analysis of independent samples that were not subject to Gaussian distribution laws was performed using the Mann-Whitney U-test. The correlation coefficient (r) was used to estimate the degree of correlation between the samples. The average fasting glucose level in patients of group 1 was 17.48±6.78 mmol / l; 2nd – 5.57±0.84 mmol / l; in the control group – 4.64±0.67 mmol / l; (p1-2 <0.00001, p1-3 <0.00001, p2-3 <0.0001). The mean insulin level in patients of group 1 was 36.19±3.5 μIU / ml; 2nd – 16.08±5.08 μOD / ml; in the control group – 8.77±0.52 μOD / ml (p1-2 <0.00001, p1-3 <0.00001, p2-3 <0.001). The average level of glycosylated hemoglobin in patients of group 1 was 8.58±0.95 μmol of fructose / gHb; 2nd – 5.6±0.2 μmol fructose / gHb, in the control group – 5.4±0.33 μmol fructose / gHb (p1-2 <0.00001, p1-3 <0.00001, p2- 3<0.05). The value of the HOMA index in patients of the 1st group was equal to – 30.39±13.33; 2nd – 3.89±1.39, in the control group – 1.81±0.27 (p1-2 <0.00001, p1-3 <0.00001, p2-3 <0.05). When re-measured after 6 months, these indicators were significantly lower, significantly higher levels of carbohydrate metabolism in patients with type 2 DM. Thus, the carbohydrate profile in patients with acute myocardial infarction was significantly higher in the presence of concomitant type 2 diabetes mellitus, indicating the presence of insulin resistance, hyperinsulinemia and stress hyperglycemia on the background of a coronary event. After 6 months, the above indicators in both groups were significantly lower, there was a direct relationship with the presence of type 2 diabetes mellitus and its degree.