Glucose intolerance is common in Japanese patients with acute coronary syndrome who were not previously diagnosed with diabetes
Glucose intolerance is common in Japanese patients with acute coronary syndrome who were not previously diagnosed with diabetes
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DOI：
10.2337/diacare.28.5.1182
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发表时间：
2005-05-01
期刊：
影响因子：
16.2
通讯作者：
Mochizuki, S
中科院分区：
文献类型：
--
作者：
Hashimoto, K;Ikewaki, K;Mochizuki, S
目的：餐后高血糖已成为一种新的糖代谢状态，与冠状动脉疾病的高风险相关。因此，我们试图评估那些以前没有被诊断为糖尿病并且空腹血糖浓度不是>；=7 mmol/L或HbA(1c)水平>；6.0%的急性冠脉综合征患者发生挑战后高血糖的频率。我们进一步将挑战后高血糖的存在与冠状动脉粥样硬化的程度联系起来。研究设计与方法--总共，134名符合上述纳入标准的连续的急性冠脉综合征患者被研究。结果：受试者的平均年龄为60岁，空腹血糖为5.15 mm ol/L，糖化血红蛋白为5.4%。在急性冠脉综合征患者中，糖耐量减低(IGT)50例(37%)，糖尿病13例(10%)。胰岛素抵抗的稳态模型评估在正常糖耐量(NGT)组、IGT组和糖尿病组之间没有显著差异。然而，与NGT患者相比，糖尿病患者的胰岛素生成指数更低，狭窄的血管数量更多。结论主要由初始胰岛素分泌受损引起的挑战后高甘油症常见于以前没有被诊断为糖尿病的日本ACS患者，这种现象被认为与晚期冠状动脉粥样硬化有关。因此，本研究有力地支持了口服糖耐量试验对挑战后高血糖的评估对于在日本ACS患者中识别任何以前未被诊断的糖尿病病例至关重要的观点。
OBJECTIVE - Postprandial hyperglycemia has emerged as a new glycometabolic condition associated with an excessive risk for coronary artery disease. We therefore attempted to evaluate the frequency of postchallenge hyperglycemia in patients with acute coronary syndrome (ACS) who were not previously diagnosed to have diabetes and did not have a fasting glucose concerttration of >= 7 mmol/l or an HbA(1c) level > 6.0%. We further correlated the presence of postchallenge hyperglycemia with the extent of coronary atherosclerosis.RESEARCH DESIGN AND METHODS - in all, 134 consecutive ACS patients who Met the above inclusion criteria were studied. An oral glucose tolerance test was performed before discharge.RESULTS - The mean age, fasting glucose, and HbA(1C) were 60 years, 5.15 mmol/l, and 5.4%, respectively. Among ACS patients, impaired glucose tolerance (IGT) and diabetes were found in 50 (37%) and 13 patients (10%), respectively. The homeostasis model assessment for insulin resistance did not differ substantially among the normal glucose tolerance (NGT), IGT, and diabetic groups. Insulinogenic index, however, was lower and the number of stenosed vessels higher in diabetic patients compared with NGT patients.CONCLUSIONS - Postchallenge hyperglycerma, caused primarily by impaired initial insulin secretion, is commonly found in Japanese ACS patients who have not been previously diagnosed with diabetes, and this phenomenon is considered to be associated with advanced coronary atherosclerosis. Therefore, the present study strongly supports the notion that oral glucose tolerance test assessment of postchallenge hyperglycemia is essential to identify any previously undiagnosed diabetes cases among Japanese ACS patients.