Endocrine Abstracts

In a large sample of elderly patients with acute myocardial infarction, higher glucose levels were associated with a greater risk of 30-day mortality in patients with diabetes compared to patients without diabetes. In addition to previous hypothesis for mechanism of harm, recent studies have concluded that stress hyperglycaemia is an independent predictor of left ventricular remodelling after anterior myocardial infarction and may also contribute to arrhythmias.

There has also been a recent focus on biomarkers and tools to predict the risk of stress hyperglycaemia, future diabetes and outcomes from intervention. Higher cortisol levels have been found to be predictive of the onset of stress hyperglycaemia as well as of subsequent normalisation of blood glucose levels. In the case of the latter it is suggested that higher cortisol levels reflect stress-precipitated hyperglycaemia whereas lower cortisol levels suggest ‘underlying glucose intolerance’ as the most likely explanation for hyperglycaemia.

HbA1c has also been studied with varying results. One study found that hyperglycaemia and non-elevated HbA1c was associated with a poor prognosis following acute myocardial infarction whereas another study did not find any association between mortality and HbA1c.

Another recent field of interest has been hperglycemia in setting of pulmonary disease. Stress hyperglycaemia is seen in up to 50% of patients hospitalised with exacerbations of chronic obstructive pulmonary disease and each 1 mmol/l increase in blood glucose has been shown to increase the absolute risk of death or prolonged hospital stay by 15%. Prospective studies are currently underway to determine whether blood glucose control can improve chronic obstructive pulmonary disease exacerbation outcomes. A similar picture has been identified with pneumonia.