22 August 2005

Unrecognized Diabetes Among Heart Patients

Among 1,199 patients who presented with ACS, 321 (27%) had known DM on admission. After excluding these, an additional 126 of 878 patients (14%) met criteria for a diagnosis of new-onset DM. Another 252 of 878 patients (29%) received a new diagnosis of impaired fasting glucose metabolism. - From the American Journal of Cardiology, August 2005

New interesting research reveals that for patients who suffer a heart attack or have severe coronary heart disease --- acute cornonary syndrome or ACS --- symptoms of diabetes often present itself also, but the condition goes unrecognized and no clinical management is initiated to treat the impaired glucose metabolism.
Dr. Darcy Green Conaway told Reuters Health that "the majority of patients" who are seen in emergency rooms with a heart attack or heart-related chest pain "have impaired glucose metabolism," and this represents an opportunity for doctors to intervene. "Only once we recognize what we are missing can we then improve it."

"Importantly, we found a substantial number of patients who had high fasting plasma glucose levels," a pre-diabetes sign, but none of these patients received such a diagnosis.

Conaway and colleagues conclude in their report that "one way to 'catch' some of these undiagnosed patients" is to use a simple blood glucose test to screen people who go to the hospital because of a heart attack or severe chest pain.

[ Reuters Health, Aug 22 2005 ]

I suspect the reason why high fasting plasma glucose (FPG) levels go undetected and unmanaged is because doctors most often see the rise in FPG levels as a normal outcome of the stress of a heart attack. Any form of stress tend to increase our blood glucose levels, our body's other way of responding to the fight-or-flight stimuli. Doctors don't usually get surprised when greeted with elevated FPG levels in patients with acute coronary syndromes (ACS).

The authors of the study however, quote another revealing study that most patients who have newly-diagnosed diabetes during hospitalization for ACS continue to have increased glucose levels even after 3 months of the initial hospitalization or consult.

Read the full text of the study: Frequency of Undiagnosed Diabetes Mellitus in Patients With Acute Coronary Syndrome

2 reactions:

Doctor_Potato said...

That's so true! When we point out the increased blood levels to the consultants, they usually say, "oh, that's just stress, we expect that," unless if the FBS is really really high, by which time they'll start to think of DM. I guess it would be best if another test is done if the patient wasn't stressed anymore, like just before discharge, (unfortunately, these are also the tests that some consultants don't even look at anymore). It's me--Potato

Dr. Emer said...

Hello, Dr Potato. Well I do hope they get a copy of the study and start considering this new development in their medical management. I can also theorize that a heart attack or the frequency of heart attacks make up what may be considered as the "last straw" which transforms a stage/phase of reversible impaired glucose metabolism into an irreversible one. Hence, the consistent finding of elevated blood sugar levels even after 3 months of hospitalization.