Dynamics of carbohydrate metabolism in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus during 6 months of follow-up

Keywords: acute myocardial infarction, type 2 diabetes mellitus, carbohydrate metabolism.

Abstract

Annotation. Hyperglycemia complicates the course of acute myocardial infarction (AMI) and is associated with its unfavorable prognosis. The aim of the study was to analyze the dynamics of carbohydrate metabolism in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus during 6 months of follow-up. The study involved 120 patients: group 1 – patients with AMI with diabetes mellitus (DM) type 2 (n=70), group 2 – patients with AMI (n=50) and 20 people who made up the control group. All patients underwent general instrumental and clinical examinations. Statistical processing of the results was performed using the software package “Statistica 6.0” (USA) with calculation: M ± m, probability and level of reliability (p) for comparison of samples. The analysis of independent samples that were not subject to Gaussian distribution laws was performed using the Mann-Whitney U-test. The correlation coefficient (r) was used to estimate the degree of correlation between the samples. The average fasting glucose level in patients of group 1 was 17.48±6.78 mmol / l; 2nd – 5.57±0.84 mmol / l; in the control group – 4.64±0.67 mmol / l; (p1-2 <0.00001, p1-3 <0.00001, p2-3 <0.0001). The mean insulin level in patients of group 1 was 36.19±3.5 μIU / ml; 2nd – 16.08±5.08 μOD / ml; in the control group – 8.77±0.52 μOD / ml (p1-2 <0.00001, p1-3 <0.00001, p2-3 <0.001). The average level of glycosylated hemoglobin in patients of group 1 was 8.58±0.95 μmol of fructose / gHb; 2nd – 5.6±0.2 μmol fructose / gHb, in the control group – 5.4±0.33 μmol fructose / gHb (p1-2 <0.00001, p1-3 <0.00001, p2- 3<0.05). The value of the HOMA index in patients of the 1st group was equal to – 30.39±13.33; 2nd – 3.89±1.39, in the control group – 1.81±0.27 (p1-2 <0.00001, p1-3 <0.00001, p2-3 <0.05). When re-measured after 6 months, these indicators were significantly lower, significantly higher levels of carbohydrate metabolism in patients with type 2 DM. Thus, the carbohydrate profile in patients with acute myocardial infarction was significantly higher in the presence of concomitant type 2 diabetes mellitus, indicating the presence of insulin resistance, hyperinsulinemia and stress hyperglycemia on the background of a coronary event. After 6 months, the above indicators in both groups were significantly lower, there was a direct relationship with the presence of type 2 diabetes mellitus and its degree. 

Downloads

Download data is not yet available.

References

[1] Ametov, A. S., Pugovkina, Ya. V., & Chernikova, N. A. (2016). Управление гипергликемией при остром коронарном синдроме. Проблемы и решение [Management of hyperglycemia in acute coronary syndrome. Problems and solution]. Медицинский совет – Medical advice, 3, 98-105.
[2] Amr, A. Y., & Heba, M. E. (2017). Predictive Value Of Admission Blood Glucose Level In Patients With Acute Myocardial Infarction. ClinicalTrials.gov. Identifier: NCT03164707
[3] Dedov, I. I., Shestakova, M. V., & Galstyan, G. R. (2015). Алгоритмы специализированной медицинской помощи больным сахарным диабетом [Algorithms for specialized medical care for patients with diabetes mellitus]. Сахарный диабет – Diabetes mellitus, 18(1S), 1-112.
[4] Gormeli, K. N., Orak, M., & Ustundag, M. (2018). Relation between Stress Hyperglycemia and Mortality in Patients with Acute Myocardial Infarction. EJMO, 2(3), 138-141. http://dx.doi.org/10.14744 / ejmo.2018.49469
[5] Goyal, A., Mahaffey, K., Garg, J., Nicolau, J. C., Hochman, J. S., Weaver, W. D., … & Granger, C. B. (2006). Prognostic significance of the change in glucose level in the first 24h after acute myocardial infarction: results from the CARDINAL study. Eur Heart J., 27(11), 1289-1297. https://doi.org/10.1093/eurheartj/ehi884
[6] Kozhukhov, S. M., Parkhomenko, O. M., & Irkin, O. I. (2014). Гостра серцева недостатність у хворих на інфаркт міокарда зі збереженою фракцією викиду лівого шлуночка: клініко-гемодинамічні, електрофізіологічні особливості та вплив на прогноз [Acute heart failure in patients with myocardial infarction with preserved left ventricular ejection fraction: clinical and hemodynamic, electrophysiological features and impact on prognosis]. Медицина невідкладних станів – Emergency medicine, 3(58), 126-135.
[7] Moin, A. S., Nandakumar, M., Al-Qaissi, A., Sathyapalan, T., Atkin, S. L., & Butler, A. E. (2021). Potential Biomarkers to Predict Acute Ischemic Stroke in Type 2 Diabetes. Front Mol Biosci., 8, 744459. doi: 10.3389/fmolb.2021.744459
[8] Plakht, Y., Hirsch, Y. E., Shiyovich, A., Tailakh, M. A., Liberty, I. F., & Gilutz, H. (2021). Heterogenicity of diabetes as a risk factor for all-cause mortality after acute myocardial infarction: Age and sex impact. Diabetes Res Clin Pract., 182, 109117. doi: 10.1016/j.diabres.2021.109117
[9] Qin, Y., Qiao, Y., Wang, D., Tang, C., & Yan, G. (2022). Admission Hyperglycemia is Associated with Global Registry of Acute Coronary Events Score and Complications Following Acute Myocardial Infarction During 1-Year Follow-Up. Angiology, 73(2), 165-176. doi: 10.1177/00033197211039915
[10] Schiele, F., Descotes-Genon, V., Seronde, M. F., Blonde, M. C., Legalery, P., Meneveau, N., … & Bassand, J-P. (2006). Predictive value of admission hyperglycaemia on mortality in patients with acute myocardial infarction. Diabet Med., 23(12), 1370-6. doi: 10.1111/j.1464-5491.2006.02000.x
[11] State Statistics Service of Ukraine. (2021). The number of deaths in Ukraine in 2021 (cause of death) [Кількість померлих в Україні в 2021 році (за причинами смерті)]. Retrieved from https://index.minfin.com.ua/ua/reference/people/deaths/2021/
[12] Terenda, N. O. (2015). Тенденції та прогноз поширеності стенокардії та інфаркту міокарда в Україні [Trends and prognosis of angina and myocardial infarction in Ukraine]. Вісник соціальної гігієни та організації охорони здоров’я України – Bulletin of Social Hygiene and Health Care Organization of Ukraine, 3 (65), 35-40.
Published
2022-03-28
How to Cite
Feldman, D. A. (2022). Dynamics of carbohydrate metabolism in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus during 6 months of follow-up. Reports of Vinnytsia National Medical University, 26(1), 59-65. https://doi.org/10.31393/reports-vnmedical-2022-26(1)-11