Endocrinology and Nutrition Department, Hospital Universitario Carlos Haya, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Málaga, Spain; CIBERDEM (CB07/08/0019) of the Instituto de Salud Carlos III, Barcelona, Spain.
Eur J Clin Invest. 2013 Oct;43(10):1060-8. doi: 10.1111/eci.12144. Epub 2013 Aug 24.
(i) To evaluate glucometabolic status of patients without known diabetes hospitalized due to coronary artery disease (CAD), (ii) to assess markers of systemic inflammation determined during admission and to evaluate their relationship with glucometabolic status and (iii) to analyse usefulness of HbA1c determined during admission in patients with CAD to detect abnormal glucose regulation (AGR).
MATERIALS & METHODS: We studied 440 patients with CAD admitted to the cardiology ward. Patients were grouped in four groups during admission according to clinical data, fasting plasma glucose and HbA1c: diabetes, HbA1c > 5·9%, stress hyperglycaemia (SH) and normal. In 199 subjects without known diabetes, an oral glucose tolerance test (OGTT) was performed 3 months after discharge, and they were reclassified according to WHO 1998 criteria. Biochemical and inflammatory markers were measured.
The OGTT showed that 27·4% of subjects without known diabetes at admission had diabetes, 11·2% had impaired fasting glucose + impaired glucose tolerance, 33·5% impaired glucose tolerance, 3·6% impaired fasting glucose, and 24·4% normal glucose metabolism. Odds ratio for having diabetes 3 months after discharge in HbA1c > 5·9% group was 5·91 (P < 0·0001) and in SH group was 1·82 (P = 0·38). The best HbA1c cut-off point to predict AGR was 5·85%. HbA1c levels during admission were highly predictive of having AGR (AUC ROC 0·76 [95% CI 0·67-0·84]).
We reported a high prevalence of AGR in subjects with CAD. Stress hyperglycaemia in patients with CAD was not associated with an increased risk of diabetes 3 months later. HbA1c in patients hospitalized with CAD was a useful tool to detect AGR.
(i) 评估因冠状动脉疾病 (CAD) 住院但无已知糖尿病的患者的糖代谢状态，(ii) 评估入院期间确定的系统炎症标志物，并评估其与糖代谢状态的关系，以及 (iii) 分析入院时测定的糖化血红蛋白 (HbA1c) 在 CAD 患者中检测异常血糖调节 (AGR) 的有用性。
我们研究了 440 例因 CAD 住院的患者。根据临床数据、空腹血糖和 HbA1c，患者在入院期间分为四组：糖尿病组、HbA1c＞5.9%组、应激性高血糖 (SH) 组和正常组。在 199 例无已知糖尿病的患者中，在出院后 3 个月进行口服葡萄糖耐量试验 (OGTT)，并根据 1998 年 WHO 标准重新分类。测定生化和炎症标志物。
OGTT 显示，入院时无已知糖尿病的患者中，27.4%患有糖尿病，11.2%患有空腹血糖受损+糖耐量受损，33.5%患有糖耐量受损，3.6%患有空腹血糖受损，24.4%的患者血糖代谢正常。HbA1c＞5.9%组和 SH 组出院后 3 个月发生糖尿病的比值比分别为 5.91（P＜0.0001）和 1.82（P=0.38）。预测 AGR 的最佳 HbA1c 截断值为 5.85%。入院时的 HbA1c 水平对 AGR 有高度预测性（ROC AUC 0.76[95%CI 0.67-0.84]）。
我们报告了 CAD 患者中 AGR 的高患病率。CAD 患者的应激性高血糖与 3 个月后发生糖尿病的风险增加无关。入院时的 HbA1c 是检测 AGR 的有用工具。
