Undiagnosed Diabetes and Prediabetes in Patients with Chronic Coronary Syndromes-An Alarming Public Health Issue.

Natalia Drobek,Paweł Kozieł,Andrzej Pająk,Irina Kowalska,Jacek Jamiołkowski,Paweł Sowa,Małgorzata Setny,Maciej Haberka,Danuta Czarnecka,Karol Kamiński,Marlena Paniczko,Dariusz Kosior,Piotr Jankowski,Karolina Szostak-Janiak,Zbigniew Gąsior,Agnieszka Krzykwa

doi:10.3390/jcm10091981

Abstract

Dysglycemia is a public health challenge for the coming decades, especially in patients with chronic coronary syndromes (CCS). We want to assess the prevalence of undiagnosed diabetes mellitus (DM) and prediabetes, as well as identify factors associated with the development of dysglycaemia in patients with CCS. In total, 1233 study participants (mean age 69 ± 9 years), who, between 6 and 18 months earlier were hospitalized for acute coronary syndrome or elective revascularization, were examined (71.4% men). The diagnosis of DM, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) have been made according to World Health Organization (WHO) criteria. Based on the oral glucose tolerance test (OGTT) results, DM has been newly diagnosed in 28 (5.1%, mean age 69.9 ± 8.4 years) patients, 75% were male (n = 21). Prediabetes has been observed in 395 (72.3%) cases. IFG was found in 234 (42.9%) subjects, 161 (29.5%) individuals had IGT. According to multinomial logistic regression, body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) should be considered when assessing risk of development of dysglycaemia after discharge from the hospital. Among people with previously diagnosed DM, a significantly higher percentage were willing to change their lifestyles after the index event compared to other patients. Patients with chronic coronary syndromes suffer a very high frequency of dysglycaemia. Most patients with chronic coronary syndromes, especially those with high BMI or low HDL-C, should be considered for screening for dysglycemia using OGTT within the first year after hospitalization. A higher percentage of patients who were aware of their diabetic status changed their lifestyles, which added the benefit of timely diagnosis and treatment of diabetes.

Highlights

Diabetes mellitus (DM) has been called a public health challenge for the coming decades
The aim of the study was to assess the prevalence of undiagnosed diabetes mellitus (DM) and prediabetes in patients with chronic coronary syndromes (CCS), as well as identify factors associated with the development of dysglycaemia in patients with CCS
After exclusion of patients for whom we did not have any information concerning diabetic status or fasting glucose (n = 121), the examined group was classified into smaller subgroups according to the following criteria: (1) Individuals with previously diagnosed DM: on the basis of information from the hospital discharge letter or data collected during an interview, i.e., taking hypoglycemic drugs or information about diabetes diagnosis provided by medical personnel in the past

Summary

Introduction

Diabetes mellitus (DM) has been called a public health challenge for the coming decades. Many epidemiological studies revealed that patients with DM had significantly higher risk of cardiovascular diseases, cardiovascular death and neurodegenerative disorders. Both atherosclerosis and glucose metabolism disorders have similar risk factors [1]. DM is a group of metabolic disorders characterized by increased levels of blood glucose, resulting from defects in insulin secretion or insulin action, or both. The risk of cardiovascular disease (CVD) is doubled in DM [2] and about 75% of deaths in people with diabetes are due to coronary artery disease [3]. The close association between DM and coronary atherosclerosis have been previously described [4]

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