Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes

OBJECTIVE - individuals with diabetes have an increased morbidity from acute myocardial infarction (AMI). Based on an oral glucose tolerance test (OGTT), 40-45% of patients with AMI have diabetes. The objective of this study was to characterize the glucometabolic profile of b l ic pertur at ons patients with AMI without known diabetes and to see if sustained glucometa are predictable during the hospital phase of the disease. RESEARCH DESIGN AND METHODS - A total of 145 patients with AMI and no previous diagnosis of diabetes were subjected to an OGTT at hospital discharge and 3 months thereafter. Based on the OGTT after 3 months, they were defined as having normal glucose tolerance (NGT; It = 50), impaired glucose tolerance (IGT; n = 59), or diabetes (n = 36). Components of the metabolic syndrome, including insulin resistance assessed by homeostasis model assessment (HOMA-IR), were recorded. RESULTS - Patients with AMI had no changes in insulin resistance from hospital discharge to follow-up. An OGTT and/or a Single blood glucose taken 60 min (BG-60) after ingestion of 75 g glucose at hospital discharge were predictors of the outcome of the OGTT at follow-up With a cutoff value for BG-60 of 8.6 mmol/l, 70% of the patients were correctly predicted as either belonging to the NGT group or the IGT/diabetes group after 3 months. Age, BMI, antihypertensive treatment, HbA(1c) fasting blood glucose, blood lipids, insulin, proinsulin, HOMA-IR, and plasminogen activator inhibitor I did not add predictive power. CONCLUSIONS - Patients with AMI and no previous diagnosis of diabetes have no changes in insulin resistance from hospital discharge to a 3-month follow-up. An OGTT or a single BG-60 performed at hospital discharge predicts the diagnosis of IGT or diabetes 3 months. thereafter.