Glucose homeostasis abnormalities in cardiac intensive care unit patients
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The aim of this study was to characterize the abnormalities in glucose homeostasis in intensive care unit patients following an acute coronary event. The study population included all non-diabetic patients ages 20–80 years that were admitted to a coronary intensive unit. Glucose, insulin and C-peptide levels during an oral glucose tolerance test (OGTT) were measured during the acute admission. From January to September 2003, 277 patients were admitted to the coronary unit. Of these, 127 patients underwent an OGTT. Of these, only 29 patients (23%) exhibited normal glucose metabolism. The remainder had type 2 diabetes (32%), impaired glucose tolerance (37%) or isolated impaired fasting glucose (8%, 100–125 mg/dl). Based on homeostasis model assessment (HOMA) calculations, diabetic patients had impaired β-cell function and patients with elevated fasting glucose levels were insulin resistant. Beta-cell dysfunction during the acute stress seems to contribute to the glucose abnormalities. Most patients who experience an acute coronary event demonstrate abnormal glucose metabolism. Post glucose-load abnormalities are more common than abnormal fasting glucose level in this situation. It is postulated that the acute stress of a coronary event may contribute to the dysglycemia.
KeywordsCoronary disease Diabetes mellitus Impaired glucose tolerance Impaired fasting glucose Insulin resistance
This study was supported by a grant from the Israeli Association for the Study of Diabetes. The authors wish to thank the nursing staff of the ICCU for their help in this work, and Dr. Aubrey Stoch for his help in preparing the manuscript.
Conflict of interest statement
- 3.Tai ES, Goh SY, Lee JJM, Wong MS, Heng D, Hughes K, Chew SK, Cutter J, Chew W, Gu K, Chia KS, Tan CE (2004) Lowering the criterion for impaired fasting glucose: impact on disease prevalence and associated risk of diabetes and ischemic heart disease. Diabetes Care 27:1728–1734PubMedCrossRefGoogle Scholar
- 14.Hanefeld M, Koehler C, Fuecker K, Henkel E, Schaper F, Temelkova-Kurktschiev T (2003) Insulin secretion and insulin sensitivity pattern is different in isolated impaired glucose tolerance and impaired fasting glucose: the risk factor in impaired glucose tolerance for atherosclerosis and diabetes study. Diabetes Care 26:868–874PubMedCrossRefGoogle Scholar
- 23.Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, Anfossi G, Costa G, Trovati M (2006) Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga diabetes study. J Clin Endocrinol Metab 91:813–819PubMedCrossRefGoogle Scholar
- 30.Bartnik M, Rydén L, Ferrari R, Malmberg K, Pyörälä K, Simoons M, Standl E, Soler-Soler J, Öhrvik J (2004) The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: the Euro heart survey on diabetes and the heart. Eur Heart J 25:1880–1890PubMedCrossRefGoogle Scholar
- 33.Wallander M, Bartnik M, Efendic S, Hamsten A, Malmberg K, Ohrvik J, Ryden L, Silveira A, Norhammar A (2005) Beta cell dysfunction in patients with acute myocardial infarction but without previously known type 2 diabetes: a report from the GAMI study. Diabetologia 48:2229–2235PubMedCrossRefGoogle Scholar