title: Glucometabolic responses during Glucose Tolerance Test: a comparison between known diabetes and newly detected diabetes after acute myocardial infarction.
abstract: BACKGROUND
  Glucose Tolerance Test (GTT) newly detects diabetes (new diabetes) in a substantial number of patients without a history of diabetes (known diabetes) after acute myocardial infarction (AMI). Patients with new diabetes have poor outcomes, despite their lower HbA1c levels.
  
  
  METHODS
  This study consisted of 53 patients with new diabetes and 47 patients with known diabetes who underwent GTT 1 week after AMI. Sixty-eight patients with normal GTT and 78 patients with impaired glucose tolerance served as control. Plasma glucose and insulin were measured at fasting, 30 m, 60 m and 120 m after glucose load. Peak glucose-fasting glucose was used as a measure of glucose fluctuation. Homeostasis model assessment of insulin resistance and the Stumvoll's equations were used to assess insulin sensitivity and ß-cell function, respectively.
  
  
  RESULTS
  Fasting glucose (115 ± 20 mg/dl versus 129 ± 41 mg/dl, p=0.02) and hemoglobin A1C (5.7 ± 0.5% versus 6.7 ± 1.4%, p<0.001) in new diabetes were significantly lower than known diabetes. Insulin sensitivity was similarly impaired in both new diabetes and known diabetes (3.2 ± 2.2 versus 3.0 ± 1.9, p=0.58). Impairment of insulin secretion was less severe in new diabetes than in known diabetes. Peak glucose-fasting glucose was significantly greater in diabetic patients than inpatients with normal GTT (75 ± 30 mg/dl, p<0.001) and impaired glucose tolerance (95 ± 24 mg/dl, p<0.001), with no difference between new diabetes and known diabetes (156 ± 36 mg/dl versus 165 ± 57 mg/dl, p=0.36).
  
  
  CONCLUSIONS
  These findings suggested that insulin resistance and exaggerated glucose fluctuation could be attributable to poor outcomes after AMI in patients with new diabetes.
authors.affiliation: Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. ishifami@fb3.so-net.ne.jp
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Inoue
authors.forename: Takuji
authors.initials: T
authors.lastname: Kawagoe
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shimatani
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kurisu
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Nakama
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kagawa
authors.forename: Kazuoki
authors.initials: K
authors.lastname: Dai
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ootani
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikenaga
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Kentarou
authors.initials: K
authors.lastname: Ejiri
authors.forename: Nozomu
authors.initials: N
authors.lastname: Oda
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human