Rathmann W, Icks A, Haastert B, Giani G, Löwel H, Mielck A
Department of Biometrics and Epidemiology Diabetes Research Institute, Heinrich Heine University, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
Z Kardiol. 2002 Aug;91(8):620-5. doi: 10.1007/s00392-002-0826-y.
To determine the prevalence of undiagnosed diabetic subjects in a group of long-term myocardial infarction (MI) survivors and to investigate their cardiovascular risk factors and medical care.
Glucose tolerance (OGTT WHO 1985), cardiovascular risk factors (blood pressure, lipids, urinary albumin), and primary medical care during the previous year were assessed among 244 patients without previously known diabetes (mean age +/- SD: 70.5 +/- 6.9 yrs; 75% males; time since incident infarction: 6.5 years (median), inter-quartile range: 4-9 years) from the population-based MONICA myocardial infarction registry in Augsburg (Germany).
Proportion of undiagnosed diabetes among MI registry patients was 29/244, 12% (95%CI: 8-17%); impaired glucose tolerance was found in 27% (22-34%). Using fasting glucose according to ADA 1997 criteria, 11% (7-16%) had diabetes and 17% (12-22%) impaired fasting glucose. MI registry patients with newly detected diabetes (WHO or ADA) showed a more adverse risk factor profile (higher triglycerides, lower HDL-cholesterol, increased urinary albumin) than subjects with normal glucose tolerance after controlling for possible confounders (age, sex, time since MI, antihypertensive and lipid-lowering medication). No significant differences were observed for self-reported medical care during the previous year among diabetic compared to non-diabetic subjects (number of physician visits and basic investigations).
There was a high prevalence of undiagnosed diabetes mellitus among the selected elderly long-term MI survivors. Because mortality rate after MI has been previously shown to be increased in diabetic patients, screening for glucose intolerance appears to be as essential as for standard cardiovascular risk factors.
确定一组长期心肌梗死（MI）幸存者中未诊断出的糖尿病患者的患病率，并调查他们的心血管危险因素和医疗护理情况。
对来自德国奥格斯堡基于人群的MONICA心肌梗死登记处的244例既往无糖尿病的患者（平均年龄±标准差：70.5±6.9岁；75%为男性；自心肌梗死发病时间：6.5年（中位数），四分位间距：4 - 9年）进行葡萄糖耐量试验（1985年WHO标准的OGTT）、心血管危险因素（血压、血脂、尿白蛋白）以及前一年的基本医疗护理评估。
MI登记患者中未诊断出的糖尿病比例为29/244，即12%（95%可信区间：8 - 17%）；糖耐量受损的比例为27%（22 - 34%）。根据1997年ADA标准使用空腹血糖，11%（7 - 16%）患有糖尿病，17%（12 - 22%）空腹血糖受损。在控制了可能的混杂因素（年龄、性别、心肌梗死后时间、抗高血压和降脂药物）后，新检测出糖尿病（WHO或ADA标准）的MI登记患者显示出比糖耐量正常的患者更不利的危险因素谱（甘油三酯更高、高密度脂蛋白胆固醇更低、尿白蛋白增加）。糖尿病患者与非糖尿病患者在前一年自我报告的医疗护理方面（医生就诊次数和基本检查）未观察到显著差异。
在选定的老年长期心肌梗死幸存者中，未诊断出的糖尿病患病率很高。由于先前已表明糖尿病患者心肌梗死后的死亡率会升高，因此对糖耐量异常进行筛查似乎与对标准心血管危险因素进行筛查一样重要。
