RESEARCH ARTICLE


Postmeal Glucose Compared to Oral Glucose Tolerance in Non-Diabetic Patients with Acute Myocardial Infarction



O. T. Arola*, 1, P. I. Nevalainen2, M. Kotila3, H. Huhtala4, J. Alanko5
1 The Heart Hospital, Tampere University Hospital, Tampere, Finland.
2 Department of Internal Medicine, Tampere University Hospital, Tampere, Finland, and School of Medicine, University of Tampere, Tampere, Finland
3 Seinäjoki Central Hospital, Seinäjoki, Finland
4 School of Health Sciences, University of Tampere, Tampere, Finland
5 Valkeakoski Regional Hospital, Valkeakoski, Finland


T. Arola et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Heart Hospital, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland. Tel: +358 3 3116 611; Fax: +358 3 3116 4157; E-mail: olli.arola@sydansairaala.fi


Abstract

Background:

Abnormal glucose tolerance (AGT) in non-diabetic patients with acute myocardial infarction is associated with decreased survival compared to those with normal glucose tolerance (NGT). The aim of this study was to test if two-hour postprandial glucose (PPG2h) after a mixed meal correlates with the two-hour oral glucose tolerance test (OGTT2h).

Methods:

We prospectively enrolled 189 non-diabetic patients with acute myocardial infarction. Results: According to the oral glucose tolerance test (OGTT), 37.0% had NGT, 4.8% had impaired fasting glucose, 37.6% had impaired glucose tolerance (IGT) and 20.6% had diabetes. PPG2h after each meal correlated with OGTT2h (R2= 0.13-0.26, P<0.001). In diabetic patients, PPG2h levels after each meal were higher (p<0.01 for all) than in the IGT and NGT group. In the NGT and IGT group, PPG2h was higher after lunch and dinner than after breakfast (p<0.01), but this was not the case in the diabetic patients. In detecting diabetes compared to OGTT2h, PPG2h equal to or above 5.6 mmol/l after breakfast, 6.5 mmol/l after lunch and 7.0 mmol/l after dinner had a sensitivity of at least 76% and specificity of at least 42%. Glucose values below the cut-off values suggest that OGTT need not be evaluated. Conclusion: PPG2h is a quick, practical, simple and easy measurement in clinical practice. PPG2h correlates with OGTT but the value is lower, so PPG2h cannot be used to evaluate postprandial glycemia with the current OGTT glycemic thresholds. We therefore suggest the use of new cut-off values for PPG2h after a random meal to select patients in whom OGTT is not needed to evaluate diabetic status.

Keywords: Abnormal glucose tolerance, acute myocardial infarction, impaired glucose tolerance, newly diagnosed diabetes, oral glucose tolerance test, postprandial glucose, stress-induced hyperglycemia.