Cardiovascular Journal of Africa • SAHS Biennial Congress 2024 17 AFRICA Submission ID: 1644 Introduction Between euglycemia and diabetes is an area of prediabetes which includes impaired glucose tolerance and impaired fasting glucose. These entities, despite associated adverse outcomes, are often undiagnosed and unmanaged. Several tests are now well established for the diagnosis of pre-diabetes and diabetes. These include the fasting glucose, two-hour oral glucose tolerance test and glycosylated haemoglobin. Whilst recent literature has shown a high frequency of undiagnosed abnormal glucose metabolism in patients presenting with acute coronary syndromes, it remains unknown which of these modalities is the most sensitive in diagnosing a chronic state of dysglycemia in the acute setting. Methods This was a retrospective analysis of patients admitted to the R K Khan Hospital Coronary Care Unit between January 2006 to December 2011. Of the 2829 patients that were screened, 1933 were excluded, with only 896 eligible. All patients had a confirmed acute myocardial infarction and were not known to have diabetes mellitus. Patient with impaired renal function and known hemoglobinopathies were also excluded. A fasting plasma glucose and glycosylated haemoglobin was performed the morning after admission and an oral glucose tolerance test was conducted on day 4 of their hospital stay. Utilising the results from the above tests, patients were then classified via their glycemic profile as either euglycemic, pre diabetic or with overt diabetes mellitus. Data were analysed using Stata 14. Box-plots were utilised to provide graphical summaries of the percentile distribution of the blood glucose measurements. Association between categorical variables was assessed using the Pearson chi-square (χ2) test. Scatter plots were employed for pairwise comparison of FPG, 2hr OGTT and HbA1c. We estimated the likely true prevalence of diabetes by assuming an imperfect Gold Standard. The predictive performance of each measure against the latent diabetes outcomes was assessed using sensitivities and specificities, positive and negative predictive values. Results The study population comprised of 896 individuals, 80.58% of which presented with a STEMI. The majority of were males (70%), with an average age of 56.7 years. Most of the patients were Indian Asian (91.07%). Euglycemia occured in 65.29%, 33.48% and 20.76% of the patients by means of a fasting plasma glucose, 2 hour oral glucose tolerance test and HbA1C respectively. Utilising the fasting plasma glucose, we diagnosed 21.32% with impaired fasting glucose and 13.39% with diabetes. With the OGTT, 39.84% had impaired glucose tolerance and 26.67% diabetes. The HbA1C diagnosed 47.66% with pre diabetes and 31.58% with diabetes. Conclusion The results of our study show that of the 896 individuals admitted to the R K Khan Hospital CCU with an acute myocardial infarction, the majority have some form of abnormal glucose regulation. The prevalence of abnormal glucose regulation appears to be related to the diagnostic test utilised. Via the fasting plasma glucose almost two thirds of patients were euglycemic. However, 66.51% and 79.24 % of patients had either pre diabetes or overt diabetes mellitus using the OGTT and HbA1c respectively. It is therefore our recommendation that all patients with an acute myocardial infarction have both an admission HbA1c and pre-discharge OGTT. Name: Presenting Author Information Article Category Abstract Title UKZN drrllutchman@yahoo.com English Abstract Researchers/Clinicians - Early, mid & senior career The prevalence of undiagnosed impaired glucose regulation in patient presenting with an acute myocardial infarction Author Affiliation: Email: Dr Rohan Lutchman Science Theme Clinical Authors Name & Surname Title Expertise Affiliation Email Country Rohan Lutchman Dr Cardiologist UKZN drrllutchman@yahoo.com South Africa Naresh Ranjith Prof Cardiologist UKZN ranjith@lantic.co.za South Africa Benn Sartorius Prof Statistics University of Queensland b.sartorius@uq.edu.au Australia ORAL PRESENTATION
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