"Stress" hyperglycaemia during acute myocardial infarction: an indicator of pre-existing diabetes?
Husband, D.J.; Alberti, K.G.; Julian, D.G.
Lancet 2(8343): 179-181
1983
ISSN/ISBN: 0140-6736 PMID: 6135025 Document Number: 210571
Hyperglycemia occurring at admission in patients with suspected acute myocardial infarction is generally held to represent stress hyperglycemia. Patients (26), not previously known to be diabetic, had blood glucose values .gtoreq. 10 mmol/l on admission to a coronary care unit. Sixteen survived for 2 mo. at which time a 75 g oral glucose tolerance test (OGTT) showed diabetes in 10 (63%) and impaired glucose tolerance in 1 (WHO criteria). All those with abnormal glucose tolerance at 2 mo. had raised glycosylated HbA1 (> 7.5%) on admission, indicating pre-existing diabetes. All those with a HbA1 level over 8% had abnormal glucose tolerance. Of the 10 who died or did not have an OGTT, 7 also had raised HbA1 at admission. An admission blood glucose .gtoreq. 10 mmol/l in patients with severe chest pain is more likely to indicate previously undiagnosed diabetes than stress hyperglycemia. There is no evidence that myocardial infarction precipitates diabetes. The glycosylated Hb concentration can be used to distinguish between stress hyperglycemia and hyperglycemia caused by diabetes.