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. 2022 Apr 25:9:869395.
doi: 10.3389/fcvm.2022.869395. eCollection 2022.

Undiagnosed Impaired Glucose Tolerance and Type-2 Diabetes in Acute Myocardial Infarction Patients: Fequency, Characteristics and Long-Term Mortality

Timo Schmitz  1 , Eva Harmel  2 , Margit Heier  3   4 , Annette Peters  4   5   6 , Jakob Linseisen  1 , Christa Meisinger  1
Affiliations

Undiagnosed Impaired Glucose Tolerance and Type-2 Diabetes in Acute Myocardial Infarction Patients: Fequency, Characteristics and Long-Term Mortality

Timo Schmitz et al. Front Cardiovasc Med. .

Abstract

Background: In this study we investigated the prevalence of undiagnosed impaired glucose tolerance and type-2-diabetes (T2D) among patients with acute myocardial infarction (AMI) and prospectively analyzed whether these patients have a higher long-term mortality.

Methods: The analysis was based on 2,317 AMI patients aged 25-84 years from the population-based Myocardial Infarction Registry Augsburg, recruited between 2009 and 2014 and followed-up until 2019 (median follow-up time 6.5 years [IQR: 4.9-8.1]). AMI patients with a diagnosis of diabetes were divided into a high (>7.0%) and a low HbA1c group (≤7.0%) according to HbA1c values at admission. The remaining patients (without known diabetes) were grouped into normal (<5.7%), elevated (5.7-6.4%), and high (≥6.5%) HbA1c groups. In a multivariable-adjusted COX regression analysis, the association between HbA1c groups and long-term mortality was investigated. Linear regression models were used to identify AMI patients with elevated HbA1c values by means of personal characteristics.

Results: At admission, 29.5% of all patients reported a diagnosis of diabetes. Of all patients without known diabetes, 5.4% had HbA1c values of ≥ 6.5 and 37.9% had HbA1c values between 5.7 and 6.4%. The fully adjusted Cox regression model showed a non-significant trend toward higher long-term mortality for AMI patients with increased HbA1c values (HbA1c 5.7-6.4% HR: 1.05 [0.79-1.38], HbA1c > 6.5% HR: 1.34 [0.77-2.31]). A linear regression model including the variables admission serum glucose, BMI, age, sex and type of infarction (STEMI, NSTEMI) showed only poor prediction of HbA1c values (R 2: 11.08%).

Conclusion: A fairly high number of AMI patients without known diabetes have elevated HbA1c values. Though we could not prove a higher risk of premature mortality in these patients, early detection and adequate therapy might lead to reduced diabetes-associated complications and improve long-term outcomes.

Keywords: HbA1c; long-term mortality; myocardial infarction; prediabetes; undiagnosed diabetes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
AMI cases (n = 2,317) by diabetes status and HbA1c values.
FIGURE 2
FIGURE 2
Long-term survival by diabetes status and HbA1c values.
FIGURE 3
FIGURE 3
Correlation plots between HbA1c and continuous variables and boxplots for categorical variables for patients without known diabetes.
See this image and copyright information in PMC

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