Bedeutung des Aufnahmeblutzuckerwertes bei Infarktpatienten für die Kurz- und Langzeitletalität sowie die Entwicklung eines Diabetes mellitus Typ 2
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Several studies have shown that admission blood glucose in patients with acute coronary syndromes (ACS) is frequently elevated and associated with increased complications. We sought to investigate the association between increased admission glucose in non-diabetic patients and in patients with type 2 diabetes (T2DM) with a first myocardial infarction (MI) and 28-day as well as 1-year and 3-year-mortality and whether increased blood glucose on admission in non-diabetic patients with first MI is associated with incident type 2 diabetes mellitus (T2DM). We used the MONICA/KORA myocardial registry database in Augsburg, Germany, and included 1.631 patients without and 659 patients with type 2 diabetes (T2DM). Non-diabetic patients with admission glucose above 152 mg/dl (top quartile, Q4) compared to the bottom quartile had an odds ratio (OR) of 2.82 (95 % confidence interval, CI, 1.30 - 6.12) to die within 28 days. Patients with T2DM and admission glucose > 278 mg/dl (Q4) compared to the bottom quartile (< 152 mg/dl) showed a non-significantly increased OR of 1.45 (95 % CI, 0.64 - 3.31) in multivariable logistic regression. One- and three-year-mortality follow-up did not show an significant increased risk to die for patients in the top quartile compared to the bottom quartile of admission glucose, neither for non-diabetic patients, nor for T2DM patients. Compared to non-diabetic MI patients with blood glucose on admission < 111 mg/dl (Q1), non-diabetic patients with levels > 153 mg/dl (Q4) showed an age and sex adjusted relative risk of 2.76; (CI 95 %;1.61 - 4.72) for incident T2DM. Non-diabetic MI patients with increased blood glucose on admission have an increased risk after the acute event to develop manifest T2DM and thus need close monitoring of blood glucose and an oral glucose tolerance test. MI patients without known T2DM but increased admission blood glucose present a high risk group with poor short-term prognosis and thus need aggressive, comprehensive therapy.
Subject HeadingsDiabetes mellitus [GND]
Inzidenz <Medizin> [GND]
Diabetes mellitus, type 2 [MeSH]