Type 2 Diabetes and Acute Myocardial Infarction

Study Overview
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Brief Summary
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The present study was designed to determine the prevalence of previously unknown impaired glucose tolerance and type 2 diabetes in patients with acute ST-elevation myocardial infarction subjected to acute PCI. Secondary, a possible association between inflammation, haemostasis and abnormal glucose regulation was studied.

Detailed Description
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Background: A high prevalence of impaired glucose tolerance (IGT) and unknown diabetes mellitus (DM) in patients with cardiovascular disease has been shown. European guidelines recommend screening of patients with AMI for DM and IGT by performing an oral glucose tolerance test (OGTT). The prevalence of IGT and DM in a Norwegian population of patients with AMI is unknown. Evidence are lacking regarding the reliability of an OGTT performed early after an AMI. The present study was designed to detect unknown IGT and DM in patients with AMI and the main challenge of the study was timing and reproducibility of the OGTT. In addition, mechanisms (inflammation, haemostasis) involved in impaired glucose regulation will be studied. Design: The study is designed as an observational cohort study prospectively including 200 patients with a primary PCI treated acute STEMI admitted to the coronary care unit at Ullevål university hospital. An OGTT is performed in-hospital and repeated after 3 months and a glucometabolic classification was performed according to the results. The patients will be followed for a minimum of two-years with regards to clinical endpoints. Aims of the study: Study the prevalence of IGT and DM in a Norwegian population with acute STEMI. Validate the results of an OGTT performed early after myocardial infarction, by repeating the test after three months. Elucidate possible interactions between biomarkers of inflammation and coagulation, and the glucometabolic status. Study the relationship between impaired glucose tolerance and prognosis after STEMI. Contribute to an increased focus on undiagnosed DM and IGT in patients with coronary heart disease in Norway and the results may lead to an increased use of routine OGTT in the follow-up of patients with myocardial infarction. Investigate how patients with myocardial infarction and known glucometabolic state are followed up in real-life by their physicians. Clinical implications: The study may detect a large proportion of undetected DM and IGT in patients with AMI and change present guidelines on the follow-up of patients after AMI with increased focus on impaired glucose tolerance. The study will provide new insights about the association between inflammation, haemostasis and impaired glucose tolerance in patients with acute ST-elevation myocardial infarction.

Official Title
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Impaired Glucose Tolerance in Patients With Acute Myocardial Infarction.

Conditions
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Myocardial Infarction, Type 2 Diabetes, Impaired Glucose Tolerance, Inflammation

Intervention / Treatment
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* Other: OGTT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with acute ST-segment elevation infarction (defined from ECG), treated with primary percutaneous coronary intervention PCI)were prospectively included. Stable patients Exclusion Criteria: known DM unstable patient signs of heart failure renal failure defined as creatinine >200 umol/l

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| STEMI patients<br>Patients with acute STEMI treated by PCI without previously known type 2 diabetes. | Other: OGTT<br>* Oral glucose tolerance test (diagnostic procedure) eary after an acute STEMI and at three months follow-up.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The prevalence of abnormal glucose regulation defined by an oral glucose tolerance test (OGTT). |  | Three-months after an acute ST-elevation myocardial infarction (STEMI). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Validate the results of an OGTT performed early after myocardial infarction, |  | Repeating the test after three months. | 
| Elucidate possible interactions between biomarkers of inflammation and haemostasis, and the glucometabolic status. |  | Three months | 
| Study the relationship between abnormal glucose regulation and prognosis after STEMI. |  | Two years |