Does high-normal 2-hour post load plasma glucose after myocardial infarction in patients with normal glucose tolerance adversely affect prognosis?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Chattopadhyay ◽  
A George ◽  
J John ◽  
T Sathyapalan
Keyword(s):  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Cohort Analysis ◽  
Normal Glucose Tolerance ◽  
Rank Test ◽  
Free Survival ◽  
Net Reclassification Improvement ◽  
Normal Glucose ◽  
Group 2 ◽  
Group 1

Abstract Background Type 2 diabetes mellitus (DM) and pre-DM, newly diagnosed after MI in patients without known DM adversely affects prognosis. 2-hour post-load glucose (2h-PG) predicts post-MI prognosis better than fasting plasma glucose (FPG). Plasma glucose below the conventional threshold for the diagnosis of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), affects post-MI prognosis. Purpose To test whether high-normal post-load plasma glucose in patients with normal glucose tolerance (NGT) would affect post-MI prognosis and whether FPG or 2h-PG increases this risk. Methods Retrospective cohort analysis of 425 MI survivors without known DM and with NGT followed up for (death and non-fatal MI) as MACE. MACE in patients with 2h-PG > median for the whole cohort (Group 2), was compared with those at or below (Group 1). Event free survival in the two groups was estimated from the Kaplan–Meier curves and compared using log-rank test. Cox proportional hazard regression identified predictors of MACE. Continuous net reclassification improvement (NRI>0) and integrated discrimination improvement (IDI) and c-statistics determined the added predictive value of glycaemic matrices. Results Median 2h-PG was 6.3 mmol/l. 219 patients in Group 1 and 206 in Group 2. Group 2 had higher age, prevalence of hypertension, hypercholesterolaemia, ST-segment depression and higher heart rate and GRACE scores. Median follow-up was 40.6 months. MACE was more frequent in Group 2 than Group 1 (OR 2.82, 95% CI 1.55 to 5.16, p<0.001). MACE-free survival was higher in Group 1 (HR 2.43, 95% CI 1.53 to 3.85, p<0.001). Group 2 (HR 2.42, 95% CI 1.44 to 4.04, p<0.001) predicted the MACE-free survival. 2h-PG, but not the FPG independently predicted of MACE (HR 1.73, 95% CI 1.31 to 2.30, p<0.001). Addition of 2h-PG to models containing FPG and other variables improved their predictive performance (NRI>0 0.5062, p<0.001; IDI 0.0376, p=0.003). The c-statistic increased when 2h-PG was added to the GRACE score only model (δAUC 0.037, 95% CI 0.012 to 0.081, p=0.046). Conclusion(s) This study suggests that “high-normal” 2h-PG is an independent predictor of post-MI prognosis. Normoglycaemic patients with 2h-PG ≥6.4 mmol/l, had worse post-MI prognosis compared to those with 2h-PG ≤6.3 mmol/l. The risk of MACE increased with increasing 2h-PG within the normal range. FPG had no effect on prognosis. Funding Acknowledgement Type of funding source: None

scholarly journals Post-load glucose spike is a determinant of post-MI prognosis in patients without known or newly diagnosed diabetes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Chattopadhyay ◽  
A George ◽  
J John ◽  
T Sathyapalan
Keyword(s):  
Plasma Glucose ◽  
Cohort Analysis ◽  
Categorical Variables ◽  
Rank Test ◽  
Newly Diagnosed ◽  
Event Free Survival ◽  
Free Survival ◽  
Net Reclassification Improvement ◽  
Group 2 ◽  
Group 1

Abstract Background Post-prandial plasma glucose spikes contribute to the progression of atherosclerosis. Glycaemic variability may predict post-ACS prognosis. A third to two-thirds of these patients had diabetes mellitus (DM). Post-ACS prognosis is worse in DM than in those without. This has not been tested in patients without DM. Purpose To test whether post-load spike in plasma glucose in patients without known or newly diagnosed DM adversely affects prognosis. Methods Retrospective cohort analysis of 847 MI survivors without known or newly diagnosed DM who were followed up for MACE (death and non-fatal MI). The median post-glucose spike (PGS, defined as the difference between the 2h-PG and FPG) was 2.4 mmol/l for the whole cohort and 1.5 mmol/l for the patients with normal glucose tolerance (NGT). Group 1: PGS ≤2.4 mmol/l and Group 2: PGS >2.4 mmom/l were compared using Mann-Whitney test for continuous variables and chi-squared test for categorical variables. Event free survival in the two groups was estimated from the Kaplan–Meier curves and compared using log-rank test. Cox proportional hazard regression identified predictors of MACE. Continuous net reclassification improvement (NRI>0) and integrated discrimination improvement (IDI) and c-statistics determined the added predictive value of glycaemic matrices Results MACE was higher in group 2 (OR 1.99, 95% CI 1.36 to 2.91, p=0.0004) compared to group 1. In patients with NGT, MACE was higher in patients with PGS ≥1.5 mmol/l vs those below (OR 2.37, 95% CI 1.31 to 4.26, p=0.0041). Event free survival was worse in pre-diabetes than in the NGT groups (HR 1.57, 95% CI 1.17 to 2.12, p=0.003). and in group 2 than 1 (HR 2.01, 95% CI 1.49 to 2.71, p<0.001). Amongst the patients with NGT, event free survival was worse in patients with PGS ≥1.5 mmol/l (HR 2.09, 95% CI 1.35 to 3.25, p<0.001). PGS independently predicted MACE in the whole cohort (HR 1.16, 95% CI 1.06 to 1.26, p=0.002) and NGT group (HR 2.06, 95% 1.51 to 2.79, p<0.000). Group 2 independently predicted MACE in the whole cohort (HR 1.75, 95% CI 1.26 to 2.42, p<0.001). In the NGT group, PGS >median, independently predicted of MACE (HR 2.67, 95% CI 1.54 to 4.61, p<0.001). The c-statistic a model containing GRS only increased on addition of PGS (δAUC 0.0134, p=0.046) but not on addition of FPG. Within the whole cohort, PGS improved the net reclassification by 28% when added to the model containing GRS only. NGT cohort had higher net improvement at 46.6%. Addition of PGS to the model containing GRS and FPG resulted in NRI>0 of 25.5% in the whole cohort and 56.3% in the NGT cohort. Similar changes were seen in the IDI. Conclusion(s) PGS predicts post MI prognosis in patients without known or newly diagnosed DM including in patients with NGT. This suggests that PGS is a more powerful indicator of post-MI prognosis than FPG Funding Acknowledgement Type of funding source: None

Effect of High ß-Glucan Barley on Postprandial Plasma Glucose Levels in Subjects with Normal Glucose Tolerance and Patients with Type 2 Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 772-P
Author(s):  
MARIKO HIGA ◽  
AYANA HASHIMOTO ◽  
MOE HAYASAKA ◽  
MAI HIJIKATA ◽  
AYAMI UEDA ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Normal Glucose Tolerance ◽  
Postprandial Plasma Glucose ◽  
Glucose Levels ◽  
Normal Glucose

THE RESPONSE OF INFANTS OF DIABETIC WOMEN TO TOLBUTAMIDE AND LEUCINE AT BIRTH, AND TO GLUCOSE AND TOLBUTAMIDE AT 2 YEARS OF AGE

PEDIATRICS ◽  
1969 ◽  
Vol 43 (4) ◽  
pp. 546-557
Author(s):  
Mutya S. A. Velasco ◽  
Elsa P. Paulsen
Keyword(s):  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Newborn Infants ◽  
Normal Glucose Tolerance ◽  
Diabetic Woman ◽  
Oral Glucose ◽  
Insulin Levels ◽  
Glucose Levels ◽  
Normal Glucose ◽  
Diabetic Mothers

Twelve newborn infants, 2 to 8 days old, of gestational (IGDM) and insulin-requiring (IDM) diabetic mothers responded to intravenous tolbutamide (20 mg/kg) with abnormally large decreases in plasma glucose and marked rises in plasma insulin (the latter was measured only in IGDM). Only 3 of 13 IGDM tested with leucine had significant decreases in plasma glucose. Newborn infants of normal mothers showed no changes in glucose or insulin in response to intravenous tolbutamide, and one of five had a small decrease in glucose levels after leucine. The results suggest the presence of large stores of pancreatic insulin in newborn infants of diabetic mothers which are more readily released by stimulation with tolbutamide than with leucine. The offspring of the diabetic women were restudied at 2 years of age for their response to intravenous tolbutamide and oral glucose. Seven of nine children had normal glucose and insulin levels after intravenous tolbutamide, and two had abnormally low glucose levels with high insulin levels. Three of the nine had normal glucose tolerance with normal insulin levels. The other six had abnormally elevated glucose levels which varied in duration from one-half to 2 hours. Four of the six had an accompanying hyperinsulinemia; two, who had diabetic glucose tolerance, had poor insulin responses. The findings in the 2-year-old children support a concept that the fetal environment provided by a diabetic woman has effects on carbohydrate tolerance which extend beyond the newborn period.

scholarly journals Elevated 1‐h post‐load plasma glucose levels in Thai people with normal glucose tolerance associated with high diabetes and cardiovascular risk

2019 ◽  
Vol 37 (4) ◽  
pp. 705-706
Author(s):  
Y. Thewjitcharoen ◽  
A. Elizabeth Jones ◽  
S. Butadej ◽  
S. Nakasatien ◽  
P. Chotwanvirat ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Normal Glucose Tolerance ◽  
Glucose Levels ◽  
Normal Glucose ◽  
Thai People

The Reproducibility and Usefulness of the Oral Glucose Tolerance Test in Screening for Diabetes and other Cardiovascular Risk Factors

1998 ◽  
Vol 35 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Gary T C Ko ◽  
Juliana C N Chan ◽  
Jean Woo ◽  
Edith Lau ◽  
Vincent T F Yeung ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Roc Analysis ◽  
World Health ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

We examined the reproducibility of oral glucose tolerance tests (OGTT) using the World Health Organization criterion in 212 Chinese subjects (male 149, female 63) who underwent two 75 g OGTTs within a 6-week period. The overall reproducibility was 65.6% (139/212) of which 74 subjects had normal glucose tolerance, 24 had diabetes and 41 had impaired glucose tolerance (IGT) on two occasions. The subjects were divided into three groups [group 1: normal OGTTs on both occasions ( n = 74); group 2: one abnormal OGTT (either diabetes or IGT ( n = 51); group 3: 2 abnormal OGTTs ( n = 87)]. Subjects in group 1 were younger, had lower blood pressure, body mass index (BMI), waist-to-hip ratio (WHR), fasting and 2 h plasma insulin levels, triglyceride, very — low density lipoprotein and apolipoprotein-B concentrations than both groups 2 and 3. Group 2 had similar characteristics as group 3 except for a lower glycated haemoglobin (HbA1c), fasting and 2 h plasma glucose during the two OGTTs. With receiver operating characteristic curve (ROC) analysis, a HbA1c. of 5.3% gave an optimal sensitivity of 70.7% and specificity of 74.3% to predict diabetes as defined by a 2h plasma glucose value ≥ 11.1 mmol/L in the first OGTT. Of the 212 subjects, 73 had HbA1c ≥ 5.3%. The reproducibility of OGTT was 56.2% for these 73 subjects. With ROC analysis, a BMI of 25 kg/m2 gave an optimal sensitivity of 53.7% and specificity of 56.7% to predict diabetes. For the 36 subjects with BMI ≥ 25 kg/m2, the reproducibility of OGTT was 58.3%. Similarly, for the 140 subjects with WHR ≥ 0.9, the reproducibility of OGTT was 57.9%. These findings confirmed the poor reproducibility of OGTT which was not improved even amongst subjects with high HbA1c, BMI or WHR. Furthermore, subjects with one abnormal OGTT, whether reproducible or not, had a higher cardiovascular risk profile compared to subjects who had two normal OGTTs.

1505-P: Plasma Glucose Level at 1h Post 75g OGTT Is the Best Predictor of the Development of Glucose Intolerance in Subjects with Normal Glucose Tolerance—The Toon Health Study

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1505-P
Author(s):  
MISAKI TAKAKADO ◽  
YASUNORI TAKATA ◽  
TOSHIMI HADATE ◽  
YUMI MATSUSHITA ◽  
RYOICHI KAWAMURA ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Glucose Level ◽  
Glucose Intolerance ◽  
Plasma Glucose ◽  
Plasma Glucose Level ◽  
Normal Glucose Tolerance ◽  
Health Study ◽  
Normal Glucose
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