Acta Diabetologica

, Volume 46, Issue 3, pp 209–216 | Cite as

Glucose homeostasis abnormalities in cardiac intensive care unit patients

  • Jacob Ilany
  • Ibrahim Marai
  • Ohad Cohen
  • Shlomi Matetzky
  • Malka Gorfine
  • Idit Erez
  • Hanoch Hod
  • Avraham Karasik
Original Article

Abstract

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.

Keywords

Coronary disease Diabetes mellitus Impaired glucose tolerance Impaired fasting glucose Insulin resistance 

References

  1. 1.
    Gerstein HC (1998) Dysglycaemia: a cardiovascular risk factor. Diabetes Res Clin Pract 40(suppl):S9–S14PubMedCrossRefGoogle Scholar
  2. 2.
    Haffner SM (1998) The importance of hyperglycemia in the nonfasting state to the development of cardiovascular disease. Endocr Rev 19:583–592PubMedCrossRefGoogle Scholar
  3. 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
  4. 4.
    Tominaga M, Eguchi H, Manaka H, Igarashi K, Kato T, Sekikawa A (1999) Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose: the Funagata diabetes study. Diabetes Care 22:920–924PubMedCrossRefGoogle Scholar
  5. 5.
    Choi KM, Lee KW, Kim SG, Kim NH, Park CG, Seo HS, Oh DJ, Choi DS, Baik SH (2005) Inflammation, insulin resistance, and glucose intolerance in acute myocardial infarction patients without a previous diagnosis of diabetes mellitus. J Clin Endocrinol Metab 90:175–180PubMedCrossRefGoogle Scholar
  6. 6.
    Norhammar A, Tenerz Å, Nilsson G, Hamsten A, Efendíc S, Rydén L, Malmberg K (2002) Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 359:2140–2144PubMedCrossRefGoogle Scholar
  7. 7.
    Ramachandran A, Chamukuttan S, Immaneni S, Shanmugam RM, Vishnu N, Viswanathan V, Jaakko T (2005) High incidence of glucose intolerance in Asian-Indian subjects with acute coronary syndrome. Diabetes Care 28:2492–2496PubMedCrossRefGoogle Scholar
  8. 8.
    Avignon A, Boegner C, Mariano-Goulart D, Colette C, Monnier L (1999) Assessment of insulin sensitivity from plasma insulin and glucose in the fasting or post oral glucose-load state. Int J Obes 23:512–517CrossRefGoogle Scholar
  9. 9.
    Unwin N, Shaw J, Zimmet P, Alberti KGMM (2002) Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 19:708–723PubMedCrossRefGoogle Scholar
  10. 10.
    The expert committee on the diagnosis, classification of diabetes mellitus (2003) Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160–3167CrossRefGoogle Scholar
  11. 11.
    Kuhl J, Hilding A, Östenson CG, Grill V, Efendic S, Båvenholm P (2005) Characterisation of subjects with early abnormalities of glucose tolerance in the stockholm diabetes prevention programme: the impact of sex and type 2 diabetes heredity. Diabetologia 48:35–40PubMedCrossRefGoogle Scholar
  12. 12.
    Abdul-Ghani MA, Jenkinson CP, Richardson DK, Tripathy D, DeFronzo RA (2006) Insulin secretion and action in subjects with impaired fasting glucose and impaired glucose tolerance: results from the veterans administration genetic epidemiology study. Diabetes 55:1430–1435PubMedCrossRefGoogle Scholar
  13. 13.
    Festa A, D’Agostino R Jr, Hanley AJG, Karter AJ, Saad MF, Haffner SM (2004) Differences in insulin resistance in nondiabetic subjects with isolated impaired glucose tolerance or isolated impaired fasting glucose. Diabetes 53:1549–1555PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    Hsieh CH, Kuo SW, Hung YJ, Shen DC, Ho CT, Lian WC, Lee CH, Fan SC, Pei D (2005) Metabolic characteristics in individuals with impaired glucose homeostasis. Int J Clin Pract 59:639–644PubMedCrossRefGoogle Scholar
  16. 16.
    The DECODE Study Group (2003) Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. Diabetes Care 26:61–69CrossRefGoogle Scholar
  17. 17.
    Hanley AJG, Williams K, Stern MP, Haffner SM (2002) Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the san antonio heart study. Diabetes Care 25:1177–1184PubMedCrossRefGoogle Scholar
  18. 18.
    Abdul-Ghani MA, Tripathy D, DeFronzo RA (2006) Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose. Diabetes Care 29:1130–1139PubMedCrossRefGoogle Scholar
  19. 19.
    Monnier L, Lapinski H, Colette C (2003) Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA1c. Diabetes Care 26:881–885PubMedCrossRefGoogle Scholar
  20. 20.
    Welin L, Bresäter LE, Eriksson H, Hansson PO, Welin C, Rosengren A (2003) Insulin resistance and other risk factors for coronary heart disease in elderly men: the study of men born in 1913 and 1923. Eur J Cardiovasc Prevention Rehab 10:283–288CrossRefGoogle Scholar
  21. 21.
    Rewers M, Zaccaro D, D’Agostino R, Haffner S, Saad MF, Selby JV, Bergman R, Savage P (2004) Insulin sensitivity, insulinemia, and coronary artery disease: the insulin resistance atherosclerosis study. Diabetes Care 27:781–787PubMedCrossRefGoogle Scholar
  22. 22.
    Despres JP, Lamarche B, Mauriege P, Cantin B, Dagenais GR, Moorjani S, Lupien PJ (1996) Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 334:952–957PubMedCrossRefGoogle Scholar
  23. 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
  24. 24.
    Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2003) Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA 290:486–494PubMedCrossRefGoogle Scholar
  25. 25.
    Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M (2004) Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J 25:10–16PubMedCrossRefGoogle Scholar
  26. 26.
    UK Prospective Diabetes Study Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853CrossRefGoogle Scholar
  27. 27.
    Bock G, Man CD, Campioni M, Chittilapilly E, Basu R, Toffolo G, Cobelli C, Rizza R (2006) Pathogenesis of pre-diabetes: mechanisms of fasting and postprandial hyperglycemia in people with impaired fasting glucose and/or impaired glucose tolerance. Diabetes 55:3536–3549PubMedCrossRefGoogle Scholar
  28. 28.
    Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE (2002) Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. Diabetes Care 25:1129–1134PubMedCrossRefGoogle Scholar
  29. 29.
    Tenerz Å, Norhammar A, Silveira A, Hamsten A, Nilsson G, Rydén L, Malmberg K (2003) Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes. Diabetes Care 26:2770–2776PubMedCrossRefGoogle Scholar
  30. 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
  31. 31.
    Rathmann W, Icks A, Haastert B, Giani G, Lowel H, Mielck A (2002) Undiagnosed diabetes mellitus among patients with prior myocardial infarction. Z Kardiol 91:620–625PubMedCrossRefGoogle Scholar
  32. 32.
    Shiloah E, Witz S, Abramovitch Y, Cohen O, Buchs A, Ramot Y, Weiss M, Unger A, Rapoport MJ (2003) Effect of acute psychotic stress in nondiabetic subjects on beta-cell function and insulin sensitivity. Diabetes Care 26:1462–1467PubMedCrossRefGoogle Scholar
  33. 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

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Jacob Ilany
    • 1
  • Ibrahim Marai
    • 2
  • Ohad Cohen
    • 1
  • Shlomi Matetzky
    • 2
  • Malka Gorfine
    • 3
  • Idit Erez
    • 1
  • Hanoch Hod
    • 2
  • Avraham Karasik
    • 1
  1. 1.Institute of EndocrinologySheba Medical CenterRamat GanIsrael
  2. 2.Heart Institute, ICCUSheba Medical CenterRamat GanIsrael
  3. 3.Faculty of Industrial Engineering and ManagementTechnion, Israel Institute of TechnologyHaifaIsrael

Personalised recommendations