Diagnostics of impaired carbon metabolism in patients with ischemic heart disease.

Authors

  • G. B. Mankovsky

DOI:

https://doi.org/10.26641/2307-0404.2018.2.133698

Keywords:

diabetes mellitus, prediabetes, fasting plasma glucose, glycated hemoglobin, oral glucose tolerance test, ischemic heart disease, coronarography

Abstract

Aim of the study – to investigate the prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes using different diagnostic approaches in patients with angiographically confirmed ischemic heart disease. Materials and methods. We studied 89 patients with ischemic heart disease, mean age 62+3,6 years. All patients had angiographically confirmed atherosclerotic lesions of coronary arteries. No patient had previously diagnosed diabetes mellitus or hyperglycemia in anamnesis. All patients underwent the detailed examination to reveal hidden diabetes or prediabetes, earlier non-diagnosed: glucose tolerance, fasting plasma glucose, glycated hemoglobin were measured and standard oral glucose tolerance test was performed. Results. Based on the results of fasting plasma glucose and oral glucose tolerance test, diabetes mellitus was diagnosed in 14 (16%) patients studied, elevated glycated hemoglobin suggesting the presence of earlier non-diagnosed diabetes was found in 11 (12%) patients. Each of the 3 diagnostic approaches used allowed to diagnose patients with non-diagnosed earlier type 2 diabetes mellitus and there were no statistically significant differences in the prevalence of earlier non-diagnosed diabetes depending on the method of diagnostics used, p>0.05. Prediabetes was diagnosed much more frequently – in 47 (53%) patients while measuring glycated hemoglobin, in 43 (48%) patients based on fasting plasma glucose levels and in 28 (31%) patients according to elevated plasma glucose levels 2 hours after taking glucose. Conclusions. Our data revealed high prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes in patients with ischemic heart disease. The measurement of fasting plasma glucose, glycated hemoglobin and oral glucose tolerance test contribute each other in diagnostics of diabetes and prediabetes in the majority of cases.

Author Biography

G. B. Mankovsky

Scientific and clinical center of childrens' cardiology and cardiac surgery
Clinic for adults
Melnikova str., 24, Kyiv, 04050, Ukraine

References

Kovalenko VN. [Guidelines in cardiology: a practical guide]. Kyiv, Visha shkola, 2008;1424. Russian.

Mankovsky BN. [The prevalence of unidentified type 2 diabetes and pre-diabetes inUkraine: the results of the epidemiological study "DIAPAZON"]. Diabetes Obesity Metabolic Syndrome. 2014;5(ІІI):70-75. Russian.

American Diabetes Association. Standards of medical care in diabetes ‒ 2018. Diabetes Care. 2018;41(1):1-159.

Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, Deedwania P, et al. American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research; American Diabetes Association. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. Diabetes Care. 2015;38 (9):1777-803. doi: 10.2337/dci15-0012. Epub 2015 Aug 5.

Ning F, Tuomilehto J, Pyorala K, Onat A, Soderberg S, Qiao Q. Cardiovascular disease mortality in Europeans in relation to fasting and 2 h plasma glucose levels within a normoglycemic range. Diabetes Care. 2010;33;2211-16.

Tune JD, Goodwill AG, Sassoon DJ, Mather KJ. Cardiovascular consequences of metabolic syndrome. Transl Res. 2017;183:57-70.

Chrysant SG. Achieving blood pressure targets for prolonged cardiovascular health: a historical pers­pec­tive. https://www.ncbi.nlm.nih.gov/pubmed/28475386">Expert Rev Cardiovasc Ther. 2017;15 (7):517-23. doi: 10.1080/14779072.2017.1327348. Epub 2017 May 15.

Lenzen M, Ryden L, Ohrvik J, et al. Diabetes known or newly detected, but not impaired glucose re­gulation, has a negative influence on 1-year outcome in patients with coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart. Eur Heart J. 2006;27:2969-74.

Emerging Risk Factors Collaboration. Associa­tion of Cardiometabolic Multimorbidity With Mortality. JAMA. 2015;314(1):52-60. doi: 10.1001/jama.2015.7008

ESC Guidelines on diabetes, pre-diabetes, and car­diovascular diseases developed in collaboration with the EASD. Eur. Heart. J. 2013;34:3035-87. doi: 10.1093/eurheartj/eht108

Hu D-Y, Pan CY, Yu JM. China Heart Survey Group. The relationship between coronary artery disease and abnormal glucose regulation inChina: the China Heart Survey. Eur Heart J. 2006;27(21):2573-9. Epub 2006 Sep 19.

Farhan S, Redfors B, Maehara A, McAndrew T, Ben-Yehuda O, De Bruyne B, Mehran R, et al. Impact of Pre-Diabetes on Coronary Plaque Composition and Cli­nical Outcome in Patients With Acute Coronary Syndro­mes: An Analysis From the PROSPECT Study. JACC Cardiovasc Imaging. 2017;Oct 14. [Epub ahead of print]. doi: 10.1016/j.jcmg.2017.06.023. PMID: 29055637

International Diabetes Federation Diabetes Atlas 2018 update [Internet]. International Diabetes Fede­ration: 8th edition. Available from: http://www.idf.org/diabetesatlas/

International Expert Committee: International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327-34.

Silvio E Inzucchi, Richard M Bergenstal, John B Buse, Michaela Diamant, Ele Ferrannini, Michael Nauck, Anne L Peters, et al. Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38 (1):140-9.

Rawshani A, Rawshani A, Franzén S, Eliasson B, Svensson A-M, Miftara M, McGuire D, et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N Engl J Med. 2017;376:1407-41. doi: 10.1056/NEJMoa1608664

Doerr R, Hoffmann U, Otter W, et al. Oral glucose tolerance test and HbA1c for diagnosis of dia­betes in patients undergoing coronary angiography the Silent Diabetes Study. Diabetologia. 2011;54:2573-9.

Bartnik M, Ryden L, Malmberg K, et al. Oral glucose tolerance test is needed for appropriate clas­sification of glucose regulation in patients with coronary artery disease: a report from the Euro Heart Survey on Diabetes and the Heart. Heart. 2007;93:72-7.

Roffi M, Angiolillo DJ, Kappetein AP. Current concepts on coronary revascularization in diabetic pa­tients. Eur Heart J. 2011;32:2748-57.

How to Cite

1.
Mankovsky GB. Diagnostics of impaired carbon metabolism in patients with ischemic heart disease. Med. perspekt. [Internet]. 2018Jun.25 [cited 2024Nov.15];23(2):46-52. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/133698

Issue

Section

CLINICAL MEDICINE