Prevalence and risks of stress hyperglycemia and undiagnosed diabetes mellitus in patients with acute myocardial infarction

ABSTRACT

The prevalence of hyperglycemia and undiagnosed diabetes was assessed in 150 patients [without known diabetes] admitted to coronary care unit with cofirmed acute myocardial infarction [AMI]. Admission plasma glucose [APG] concentration was measured for all cases and glycosylated haemoglobin [HbAlc] concentration was measured in patients with hyperglycemia. With the use of APG level of > 144 mgldl and an HbAlc > 8.5% as a combined diagnostic criteria, 5.3% of patients [8/150] had previously unrecognised diabetes. 13.3% of patients with AMI had hyperglycemia without previous glucose intolerance as evidenced by normal AbAlc level. Hyperglycemia alone, without an elevated HbAlc level, is an indication of stress and is not diagnostic of diabetes. HbAlc measurment is useful for early and accurate interpertation of hyperglycemia following AMI. Four out of 20 patints with stress hyprglycemia died with cardiogenic shock. APG was higher in non-survivors than in survivors [257.7 +/- 31.3 VS 174 +/- 106.7 P < 0.001]. Of the 16 survived patients with hyperglycemia and AMI 9 developed heart failure. APG was significantly higher in patients with heart failure than compensated patients [216.6 +/- 30.3 VS 155.7 +/- 13.1 P < 9.001]. There was a correlation between APG and infarct size as estimated by creatine kinase enzyme activity in the 20 patients with stress hyperglycemia