Diabetic Medicine

AbstractGlucose intolerance is common but often remains undiagnosed and untreated in people with acute coronary syndrome. The best approach to screening for glucose intolerance post-acute coronary syndrome remains debated. The World Health Organization has recently advocated the use of HbA1c in diagnosing Type 2 diabetes. A screening strategy using HbA1c as the preferred test would be pragmatic and improve early detection and management of glucose intolerance in acute coronary care practice. In this commentary, we discuss the relevant literature and guidelines in this area and propose a simple and pragmatic algorithm based on the use of HbA1c to screen for glucose...

AbstractAims  To assess the prognostic impact of HbA1c and blood glucose level in patients with acute ST-segment elevation myocardial infarction and without diabetes. The relationship between HbA1c and acute hyperglycaemia was also explored.Methods and results  We evaluated 4793 ST-segment elevation myocardial infarction patients with baseline HbA1c and three glucose measurements in the first 24 h. First, patients were stratified into quintiles by HbA1c and mean/admission glucose level. A total of 373 deaths (7.8%) occurred at 7 days, and 486 deaths (10.1%) occurred at 30 days. There were no significant differences in 7- and 30-day mortality, and major adverse cardiovascular event rates across HbA1c...

AbstractAim  As both impaired fasting glucose and silent myocardial ischaemia are risk factors for cardiovascular disease and death, we hypothesized that these risk factors in combination would identify those subjects at the highest risk of adverse events.Methods  Healthy individuals without diabetes (n = 596, 55–75 years) were examined for silent myocardial infarction (≥ 1 mm ST-interval during ≥ 1 min) by ambulant 48-h continuous electrocardiogram monitoring and impaired fasting glucose (fasting plasma glucose 5.6–6.9 mmol/l).Results  After 6.3 years, 77 subjects met the endpoint of myocardial infarction and/or death. The prevalence of silent myocardial ischaemia at inclusion was 12.3% in subjects with impaired fasting glucose and 11.7% in subjects with...

AbstractAims  To evaluate whether fasting plasma glucose values measured early during insulin therapy can identify patients with Type 2 diabetes who may not achieve adequate glycaemic control after 6 months and will require additional treatment.Methods  Patient-level data from seven prospective, randomized, controlled studies using treat-to-target methods were pooled to evaluate the efficacy of insulin glargine. Fasting plasma glucose was measured at baseline, week 6 or 8 (6/8) and week 12. HbA1c was measured at week 24 to assess glycaemic control.Results  One thousand and thirty-six patients (56% male, 81% white) were included in the analysis (mean age 56.3 years; duration of diabetes 8.4 years). Baseline mean fasting plasma...