Should oral glucose tolerance testing be mandatory following acute myocardial infarction?
Should oral glucose tolerance testing be mandatory following acute myocardial infarction?
复制标题
DOI：
10.1111/j.1742-1241.2007.01301.x
复制
发表时间：
2007-04-01
影响因子：
2.6
通讯作者：
Millane, T.
中科院分区：
文献类型：
--
作者：
Jessani, S.;Gangopadhyay, K.;Millane, T.
据报道，在既往未诊断为糖尿病的急性心肌梗死（AMI）患者中，新发糖尿病（DM）和糖耐量受损（IGT）的患病率较高。然而，使用空腹血糖（FPG）严重低估了新检测到的DM的患病率。我们确定了当地混合种族人群中AMI后患者DM和IGT的患病率，并评估了口服葡萄糖耐量试验在此类患者中的有用性。所有非糖尿病AMI患者在出院前接受标准化口服葡萄糖耐量试验（OGTT），葡萄糖负荷为75 g。除了入院时血糖、血清胆固醇、甘油三酯、HDL胆固醇和血红蛋白A1（C）水平外，还记录了空腹和攻毒后2小时的血糖水平。我们研究了61例患者[38例（62%）男性;平均（SD）年龄64（12.5）岁]，其中70%为欧洲白色人，30%为南亚人。入院时平均（SD）血糖浓度为6.9（1.7;范围，5.8-8.1）mmol/l。分别有31%（95%CI 10-52）和33%（95%CI 12-53）的患者新诊断为DM和IGT。在新发现的糖尿病患者中，只有32%（95% CI 0-69）的FPG > 6.1 mmol/l。糖耐量正常组、IGT组和DM组12个月主要心脏不良事件发生率分别为4.5%、15%和32%。在AMI患者中，既往未诊断的DM和IGT是常见的。FPG正常的错误保证否认了很大一部分未确诊的糖尿病患者早期治疗的机会。口服葡萄糖耐量试验在这一易受感染的高危人群的诊断工作中的重要性再怎么强调也不过分。
A high prevalence of newly detected diabetes mellitus (DM) and impaired glucose tolerance (IGT) has been reported in patients with acute myocardial infarction (AMI) and no previous diagnosis of DM. However, the prevalence of newly detected DM is grossly underestimated by using fasting plasma glucose (FPG). We determined the prevalence of DM and IGT in patients post-AMI from our local mixed ethnicity population, and evaluated the usefulness of oral glucose tolerance testing in such patients. All non-diabetic subjects admitted with AMI underwent a standardised oral glucose tolerance test (OGTT) with 75 g glucose load predischarge in our institution. Fasting and 2-h postchallenge plasma glucose levels were recorded, in addition to admission plasma glucose, serum cholesterol, triglycerides, HDL cholesterol and haemoglobin A1(C)levels. We studied 61 patients [38 (62%) male; mean (SD) age, 64 (12.5) years], of whom 70% were white European and 30% South Asians. Mean (SD) plasma glucose concentration on admission was 6.9 (1.7; range, 5.8-8.1) mmol/l. Newly diagnosed DM and IGT were detected in 31% (95% CI 10-52) and 33% (95% CI 12-53) of patients respectively. Of those with newly detected diabetes only 32% (95% CI 0-69) had FPG > 6.1 mmol/l. The 12 month major adverse cardiac event rate was 4.5%, 15% and 32% in those with normal glucose tolerance, IGT and DM respectively. Previously undiagnosed DM and IGT in patients with AMI is common. The false reassurance of a normal FPG denies a significant proportion of undiagnosed diabetics the chance of early treatment. The importance of OGTT in the diagnostic work up of this vulnerable high-risk group cannot be over-emphasised.