Dysglycaemia in vascular surgery patients.
Oral glucose tolerance tests (OGTTs) have detected a pathologic glucose metabolism in up to 60% of patients with acute coronary syndromes. Only one-third of these were previously diagnosed. The purpose of this study was to determine the prevalence of abnormal glucose metabolism among vascular surgery patients.


METHODS
Between October 2006 and September 2007, 465 consecutive patients admitted to the vascular surgery unit were asked to participate in the study; however, 121 declined. Among the patients included, 68 had previously known diabetes. A total of 276 patients performed an oral glucose tolerance test (OGTT). We categorised the findings based on fasting and 2-h plasma glucose levels into four groups: diabetes mellitus, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and normal glucose metabolism. Information regarding the affected vascular bed and relevant medical history was also registered.


RESULTS
Of the 276 patients who underwent OGTT, 66 (24%) had IGT, 23 (8%) had IFG and 33 (12%) had diabetes. As many as 17 of the 33 patients with newly diagnosed diabetes would have fulfilled the criteria for diagnosis based only on their fasting glucose levels. Including the patients with previously known diabetes, the prevalence of dysglycaemia was 55% and that of diabetes 29%.


CONCLUSIONS
Total prevalence of dysglycaemia in vascular surgery patients corresponds well to that of acute coronary syndromes. The prevalence of unknown pathological glucose metabolism was 44% in our OGTT material. The use of fasting glucose as the sole diagnostic tool for diabetes would have resulted in the correct diagnosis in only half of the patients tested. OGTT should be considered as a routine investigation in non-diabetic vascular surgery patients. It remains to be seen whether early diagnosis and treatment of dysglycaemia in this patient group will influence the surgical treatment and outcome.
Department of Medicine, Haukeland University Hospital, Bergen, Norway. astor@combitel.no
M
M
Astor
E
E
Søfteland
A
A
Daryapeyma
T
T
Jonung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005215:Fasting / Q000097:blood; D005260:Female; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D015995:Prevalence; D014656:Vascular Surgical Procedures
D001786:Blood Glucose