Admission hyperglycemia in acute myocardial infarction: possible role in unveiling patients with previously undiagnosed diabetes mellitus

AIM: The aim of this study was to investigate the relationship between admission plasma glucose levels and abnormal glucose metabolism in patients with acute myocardial infarction (AMI) without a previous diagnosis of diabetes mellitus. METHODS: A total of 285 nondiabetic patients admitted with AMI were screened for glucometabolic disorders by using fasting glucose measurements during hospital stay or an oral glucose tolerance test on discharge. Patients diagnosed as having diabetes mellitus were followed-up for a mean of 60±33 months in order to confirm the diagnosis. RESULTS: There was a graded relationship between admission glucose levels and the prevalence of newly detected diabetes mellitus (group 1, <140mg/dl: 12%; group 2, ≥140<200mg/dl: 40%; group 3, ≥200mg/dl: 70.3%; P<0.0001). The admission glucose level of at least 144mg/dl was the best predictor of newly detected diabetes mellitus during hospitalization (area under the curve 0.78, P=0.0001). In multivariable analysis, patients with admission hyperglycemia had greater odds of having newly detected diabetes mellitus (odds ratio 6.6, 95% confidence interval 2.7-16.3, P=0.0001). Diabetes mellitus was confirmed in the long-term follow-up in 78% of patients diagnosed as having diabetes mellitus during hospitalization. CONCLUSION: Our finding suggests a relationship between admission glucose and previously undetected diabetes mellitus in nondiabetic patients presenting AMI. Acute hyperglycemia may help to identify high-risk patients for diabetes mellitus, who should be screened initially for glucometabolic disorders, then closely monitored and appropriately treated to improve outcome