The risk of diabetes development in long-term observation of patients with acute hyperglycaemia during myocardial infarction.

Abstract

Acute hyperglycemia in patients with myocardial infarction is an unfavorable predictive factor. However, there are limited data regarding the relationship between acute hyperglycemia and the incidence of new onsets diabetes in long-term observation. We studied the relationship between admission glycemia in patients with myocardial infarction and the future development of diabetes. In 190 patients admitted during 2004-2007 years with myocardial infarction diabetes was excluded on the basis of oral glucose tolerance test (OGTT) performed at the end of hospitalization. Patients were divided into three groups according to admission glucose level: G1 <7.8 mmol/l (<140 mg/dl); G2: 7.8-11.0 mmol/l (140-199 mg/dl); G3 ≥11.1 mmol/l (≥200 mg/dl). The groups consisted of 80 (42.1%), 94 (49.5%) and 16 (8.4%) patients, respectively for G1, G2 and G3. The mean age was 61.3±11.3 years. ST-segment elevation myocardial infarction (STEMI) was diagnosed in 158 patients (83.2%) and non-ST-segment elevation myocardial infarction (NSTEMI) in 32 patients (16.8%). A total of 15 cases (7.9% of the study group) of newly diagnosed diabetes mellitus were registered during a mean follow-up of 48.2±13.9 months. Higher incidence of new diabetes diagnosis was noticed in patients with higher glucose level on admission (5.0% vs. 7.4% vs. 25.0%, p=0.0249). Regression analysis showed two independent risk factors of diabetes development in observational period: admission glucose level considered as continuous variable with OR 1.2 (95% CI 1.0-1.4, p=0.03) and occurrence of IGT with OR 3.6 (95% CI 1.0-12.0, p=0.04). Patients with acute hyperglycemia during myocardial infarction are more likely to have diabetes in future. This group of patients requires a close monitoring of glucose metabolism after myocardial infarction.