Normal range glycemia towards higher side has been shown to have a higher risk than lower range of glycemia(1).
People with impaired glucose tolerance (IGT) with better glycemic control would be an ideal step towards prevention of coronary heart disease CHD.
Prevalence of undiagnosed diabetes remains high(2). Diagnosis of diabetes is made too late in too many patients. By the time diagnosis is made complications have already settled in(3). Diabetes may be diagnosed for the first time at the time of a major vascular event e.g. myocardial infarction.
A retrospective audit of 100 consecutive AMI between January 2000 to June 2000 in a district general hospital reveals that 32% patients had random blood glucose 7.8mmol/l or above on admission.
These patients had multiple coronary risk factors present at the time of AMI i.e. Hypertension (25%), raised lipids (9%), smoking history (37%) Family history (18%), etc. None of them were known to have diabetes or impaired glucose tolerance.
Summary of results
Total MI =100
Patients with Random Glucose >7.8 mmol/l=32 (28 male, 4 Female)
Q MI-24, Thrombolysed 21 ( With Streptokinase, Thrombolysis contraindicated in 3)
SBP>140mmHg in 19,
DBP >80mmHg in 19
Random Blood Glucose>11 mmol/l=10 ,
Cholesterol >5 in 24 patients
Screening for diabetes in high-risk populations has been recommended(4). Prevalence of undiagnosed diabetes and background cardiovascular risk in a population needs to be considered while screening for diabetes is contemplated. People with diabetes and with IGT would benefit from pharmaceutical interventions and life style changes.
Asymptomatic hyperglycaemia may exist for several years before diabetes is diagnosed. Hyperglycaemia is a marker for risk factors of coronary heart diasease. Hyperglycaemia is a risk factor independent of hypercholesterolemia, hypertension and smoking(5).
These patients may have had impaired fasting glycemia/impaired glucose tolerance or undiagnosed diabetes mellitus prior to their admission with AMI.
We recommend that patient with vascular event and random blood glucose of 7.8 mmol/l or above as well as their first degree relatives should be screened for diabetes.
03 - 04 Dec 2001
Society for Endocrinology