Silent myocardial infarction in non-insulin dependent type 2 diabetes mellitus patients with low adherence to blood glucose monitoring

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Decompensated diabetic patients frequently suffer from ischemic complications including silent ST-elevation myocardial infarction (STEMI). Purpose Aim of this study was to define prognostic value of low adherence to self-monitoring of blood glucose (SMBG) in type 2 diabetes mellitus (T2DM) patients as risk factor that leads to silent STEMI. Methods The electronic search in Cochrane Library, Scopus, PubMed and Web of Science for the period of 2016-2018 systematic literature review concentrated on types of educational interventions administered before SMBG in type 2 diabetes mellitus patients who are not using insulin was conducted. 18 studies were eligible for inclusion. We included all randomized controlled trials on SMBG education in T2DM patients compared with standard care in adult patients. As a proof of self-efficacy after SMBG glycated hemoglobin (HbA1c) was chosen as primary endpoint. Study group: 12 (7 females, 5 male, age 56-85 years) T2DM patients with non-insulin dependent diabetes for >5 years, low skills of SMBG that were admitted to surgery department with diabetic foot ulcers for the period of August 2019-September 2019 developed silent STEMI. Control group 10 (5 females, 5 males) T2DM patients that corresponded by age and study parameters, but did SMBG once a week via individual glucometers. Blood glucose, troponin I (cTnI) levels were registered. Statistical analysis:IBM SPSS Statistics v.23, RevMan5. Results During systematic review evidence indicated that a SMBG education was associated with more stress and lower rate in well-being and treatment satisfaction in comparison to a standard care (random-effects SMD: 0.45; 95% CI: 0.25-0.65; P < 0.0001). Depending on type of SMBG record subgroup analysis indicated that SMBG skills depend on SMBG education delivery. Patients that did feet checking, SMBG at least once a week had lower risk of complications development (P<0.05). STEMI development was associated with low SMBG in a form of checking only at visits to general practitioner (HR 1.15, 95% CI:1.04-1.13). Mean level of cTnI for study group patients was 0.045 ng/ml with no specific cardiac complaints. Conclusions There is a higher risk of silent ST-elevation myocardial infarction development in diabetic patients that have low SMBG skills) due to lacking information about importance of self-monitoring of blood glucose level as a predictor of cardiovascular complications.