Inclusion of Oral Glucose Tolerance Testing for Diabetes Screening in Patients with ST-elevation Myocardial Infarction.

A major aspect of modifiable cardiovascular risk is early detection and treatment of diabetes. In 2007, the European Society of Cardiology (ESC) guidelines already recommended active screening for unknown diabetes, impaired fasting glucose, or impaired glucose tolerance. Oral glucose tolerance testing can be used to diagnose diabetes or pre-diabetes in a greater proportion of patients with cardiovascular disease as using HbA1c or fasting glucose levels. Diabetes has long been recognized as a risk equivalent to coronary artery disease meaning that diabetics without prior myocardial infarctions do have a similar risk for acute myocardial infarction, stroke, or cardiovascular death as non-diabetics in secondary prevention. The diabetic risk equivalent to patients in secondary prevention from myocardial infarction resulted in similar recommendations regarding cardiovascular risk management more than a decade ago. Detection of diabetes in cardiovascular patients is very important as mortality-lowering anti-diabetic treatment strategies are now available and recommended by current guidelines in all patients after myocardial infarction regardless of presence or absence of ST-segment elevations. These recommendations are based on the favourable outcome of initial trials evaluating sodium-glucose transporter 2 inhibitors (SGLT2I) and glucagon-like peptide 1 receptor agonists (GLP1RA), which should now be initiated in medication-naı̈ve patients even as firstline therapies. In our analysis, we aimed to assess the prevalence of diabetes and pre-diabetes in real-world everyday clinical practice in patients admitted with acute ST-elevation myocardial infarction (STEMI) by performing oral glucose tolerance testing. From 1 April 2018 until 29 February 2020, 283 consecutive patients with STEMI were admitted to the Department of Cardiology & Angiology at Hannover Medical School (Table 1). Data analysis conforms to the Declaration of Helsinki. Collection of anonymized data was generally approved by the institutional review board. Blood samples for lipid profiles, metabolic parameters, creatinine kinase, and renal function were routinely obtained. Lipid profiles and HbA1c were singularly determined upon admission to intensive or cardiac care following primary percutaneous coronary intervention. Other blood samples were obtained upon admission and daily thereafter. Oral glucose tolerance testing was routinely performed at the morning of Day 4 after STEMI if patients were haemodynamically stable, did not have a history of diabetes, and had an HbA1c <6.5%. Patients remained fastening overnight and baseline glucose measurement was obtained prior to oral administration of standardized 75 g/300 mL dextrose (Accu-ChekR Dextrose O.G.-T, Roche Diabetes Care Germany, Mannheim, Germany), which was only administered if fasting plasma glucose was <_7.0 mmol/L. Another glucose sample was obtained 2 h thereafter. Patients were followed during their hospital stay, with respect to their clinical status. Patients with out-of-hospital cardiac arrest (n = 56), cardiogenic shock (n = 30), revascularization by urgent bypass surgery (n = 10), and/or those dying during the acute admission (n = 33) were excluded from further metabolic analyses leaving 208 eligible patients. Patients presenting with acute STEMI were 63± 13 years old (76% male) and had a mean HbA1c of 6.1 ± 1.1% (Table 1). Overall, of 208 patients potentially available for assessment of their glycaemic status, diabetes was known in 66 (32%) and newly diagnosed in 24 (11%)