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Prescription Diabetes Drugs
Posted by admin in Prescription Diabetes Drugs on June 17th, 2010
Blood glucose levels are useful for the initial triage of nondiabetic patients with acute coronary syndromes (ACS) and also for guiding long-term surveillance and management, Spanish researchers believe.
Interestingly, glucose levels had little short- or long-term prognostic value in ACS patients with known diabetes, however.
Belen Cid-Alvarez (Universitario de Santiago, Santiago de Compostela) and team evaluated the relationship between glucose levels and outcomes among 811 consecutive patients hospitalized with ACS. Nearly one-third of patients (31%) had diabetes mellitus and the median duration of follow-up was 18 months.
Both fasting and admission glucose levels were higher in patients who died during follow-up than in survivors, at 135 versus 114 mg/dl for fasting glucose and 148 versus 124 mg/dl for admission glucose.
Among the nondiabetic participants, there was a J-shaped relationship between fasting glucose and all-cause mortality risk that persisted after adjusting for covariates. The risk was lowest at a fasting glucose level of 110 mg/dl and significantly increased, versus the lowest risk, at levels below 90 mg/dl or above 117 mg/dl.
Outcomes in nondiabetic patients were also predicted by admission glucose levels, with the mortality risk being significantly increased at levels above 150 mg/dl.
By contrast, in diabetic patients there was no significant relationship between glucose levels ??” either on admission or fasting ??” and mortality risk.
Analysis of receiver operating characteristic curves suggested that the predictive value of fasting and admission glucose in nondiabetic individuals was comparable up to about 1 year, but that fasting glucose was significantly more accurate after about 2.5 years.
“Admission glucose appears to be primarily a marker of early risk, reflecting, at least in part, differences in stress-induced insulin resistance, etc, due to differences in infarct size and/or hemodynamic compromise,” the researchers suggest.
“The greater ability of fasting glucose to predict long-term risk may be due to its being more related to the patient’s background metabolic state.”
Writing in the American Heart Journal, the authors conclude: “According to our results, fasting glucose concentrations in nondiabetic patients hospitalized for ACS may serve as a simple marker to help clinicians stratify risk for optimal triage and long-term surveillance and management.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
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