Characteristics of carbohydrate metabolism indicators in diabetic patients with acute coronary syndrome
Authors: Halushko O. A. , Boliuk M. V. 
Published: July 2024

Studies show that all patients with uncontrolled glucose levels are at increased risk of complications during hospitalization. It has been proven that there is a relationship between the level of hyperglycemia and in-hospital mortality in patients admitted with myocardial infarction (MI). Aim. To study the features of carbohydrate metabolism indicators in diabetic patients with acute coronary syndrome. Materials and methods. The study included 48 patients (38 men and 10 women) aged 45-83 years, urgently hospitalized for acute coronary syndrome (ACS). Blood samples were collected from all patients to determine the level of glycated hemoglobin (HbA1c). Blood glucose (BG) was determined at the time of hospitalization and after revascularization. Glycemic level and glycemic interval were determined at the time of hospitalization and after revascularization using a calculation method. The relationship between the levels of glycemia, glycated hemoglobin and glycemic gap and the influence on the course of acute coronary syndrome in diabetic patients, namely the development of complications (recurrent MI, cardiac arrest, pulmonary aedema, life- threatening arrhythmias, the need for mechanical ventilation) was determined. Results. The following complications of ACS were recorded: paroxysmal tachycardia with narrow QRS complexes (4.17%); paroxysm of atrial fibrillation (4.17%); pulmonary aedema (8.34%); mechanical ventilation (4.17%). We did not observe cardiac arrest or repeated MI. The average value of glycemia at the time of hospitalization was 8.19±3.41 mmol/l. Glycemia over 10.0 mmol/l was found in 20.83% of patients, and BG over 7.0 mmol/l was observed in 47.92% of patients. After revascularization, the average value of glycemia was 6.42±1.62 mmol/l. HbA1c >6.4% was observed in 29.17% of patients, and greater than 7.0% - in 25.0% of patients. Hyperglycemia >7.0 mmol/L at the time of hospitalization was significantly (p=0.049) more common in patients with type 2 diabetes. Glycated hemoglobin and estimated average glycemia by ADAG were higher in patients with type 2 diabetes (p=0.038). There was a trend towards the predominance of increased glycated hemoglobin (>7.0 mmol/l) in patients with ACS complications (p=0.094) and differences in glycemic gap values in patients with complications (p=0.052). No correlation was found between the glycemic gap and the occurrence of ACS complications (р=0.275). Conclusions. Hyperglycemia is often observed in patients with ACS; patients with coronary artery desease often have poorly controlled diabetes; in diabetic patients with ACS complications there is a tendency to predominate in the frequency of an increased level of glycated hemoglobin (>7.0 mmol/l) (p=0.094) and differences in the values of the glycemic gap (p=0.052); glycemic gap can probably be a predictor of the development of life-threatening complications of ACS in patients with DM, and further clinical studies involving a larger number of patients of different ages and different ethnic groups are needed to reliably confirm this hypothesis.