Endocrine Abstracts

Diabetes and impaired glucose tolerance are associated with increased risk of cardiovascular diseases. Criteria for high risk populations that should be screened for diabetes needs be revising.

Hospital admissions are stressful events and abnormally high random blood glucose levels are not acted upon appropriately.

We studied 100 consecutive admissions to coronary care unit to assess the incidence of hyperglycaemia/diabetes on admission and it impact. Multiple coronary risk factors were present on admission. Hypertension 14%, Diabetes 6%, Positive family history for ischaemic heart disease 9%, hyperlipaedemia 7% whilst 19% were current smokers. Random blood glucose on admission (RBGA) more than 7 mmol per litre was noted in 53% patients. Only 6% were known to have diabetes. Thus, 47% had impaired glucose homeostasis. 11% were diagnosed diabetes for the first time at the time of coronary event. 3% died in hospital, 2% reinfarcted within 6 weeks and 5% required emergency coronary angiography.

The peak cardiac enzyme levels were higher in group A (presenting with RGBA more than 7 mmol per litre) than in group B ( RBGA of 7 mmol per litre or less). Creatinine kinase levels were 332.3 and 533.1IU per litre in group A and B respectively. Asparate transaminase levels were 149.6 and 204.7 and lactate dehydrogenase levels were 1000.1 and 1286.7 respectively in group A and B.Infarct size was larger in presence of hyperglycaemia. On discharge, fasting blood glucose was not arranged nor oral glucose tolerance test was performed to assess impaired glucose homeostasis.

Hyperglycaemia on admission to coronary unit could be due to the stress. It may also imply previously undiagnosed diabetes. It is associated with larger infarct size, higher complication rates and higher mortality

Conclusion: Every patient presenting to the coronary care unit should be screened for the presence of impaired glucose homeostasis during cardiac rehabilitation