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OGTT after MI reveals high undiagnosed diabetes, subsequent high mortality

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SAN FRANCISCO — New research looking at oral glucose tolerance testing 4 days after both ST-elevation myocardial infarction and non-ST-elevated myocardial infarction shows a significant number of patients with undiagnosed diabetes.

Mortality rates and risk for health crises remain high after MI, according to a presenter at the American Diabetes Association’s 74th Scientific Sessions.

“Although the prevalence of known diabetes was already much higher in non-STEMI, the rate of newly diagnosed diabetes was similar in non-STEMI and STEMI patients,” Anselm K. Gitt, MD, of the department of cardiology at the Klinikum Ludwigshafen in Germany, said during his presentation. “OGTT in clinical practice identified a significant amount of MI patients having impaired glucose metabolism with a high risk for subsequent events.”

Gitt and colleagues looked at 1,549 STEMI patients (20.1% with known diabetes) and 1,200 non-STEMI (30.4% with known diabetes) who were enrolled in the SWEETHEART trial in order to identify patients with newly diagnosed diabetes and observe their mortality outcome.

Oral glucose tolerance tests (OGTT) were performed 4 days after myocardial infarction and the researchers examined the impact of diabetes on 3-year outcomes.

Gitt reported that OGTT detected 16.0% of STEMI patients without diabetes were subsequently found to have diabetes while 22.1% were found to have prediabetes. Similarly, 17.8% of non-STEMI patients without diabetes were found to have diabetes while 21.3% had prediabetes. Patients with new diabetes were younger and were less likely to have concomitant diseases.

“They were younger and less sick,” Gitt said.

He showed that hospital mortality was very low and the “experienced centers” used for this study closely followed the treatment guidelines, such as aspirin use.

“If we apply the guidelines into clinical practice, we can save a lot of lives,” he said.

They concluded that 3-year mortality rates were high, both for patients with known and newly diagnosed diabetes, without differences between the STEMI and non-STEMI groups.

The population with known diabetes had a higher mortality for STEMI and non-STEMI, but in those newly diagnosed, rates of mortality at 3 years was 11.1% in the STEMI group and 13.9% in the non-STEMI group.

“As a cardiologist, I would say we should treat these patients more stringent to the guideline-recommended targets,” Gitt said. “Of course we have to treat the diabetes although we know the glucose control does not affect mortality.” — by Katrina Altersitz

For More Information: Gitt AK. Abstract 1-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.

Disclosures: Gitt reports financial relationships with AstraZeneca/Bristol-Myers Squibb and Sanofi.