Advertisement

Real Incidence of Diabetes Mellitus in a Coronary Disease Population

Published:November 19, 2012DOI:https://doi.org/10.1016/j.amjcard.2012.10.008
      The high prevalence of unknown diabetes mellitus (DM) in patients with coronary disease and that the oral glucose tolerance test (OGTT) is the best diagnostic method in this context are well known. However, data about the incidence of DM in this population have not been well described. In the present study, we sought to determine the actual incidence of new-onset DM in patients with coronary disease using the OGTT. Our secondary objective was to validate a predictive model. We studied a series of 338 patients with coronary disease without known DM using the OGTT. After the OGTT, the patients were reclassified as normoglycemic, prediabetic, and unknown DM, according to the American Diabetes Association 2010 criteria. After 3 years of follow-up, the patients without DM were again reassessed using the OGTT. We then built a predictive model using the multivariate logistic regression method and validated it using the leave-one-out method. The final sample was 191 patients. The mean follow-up was 3.13 years. The overall incidence of DM was 43.6 cases/1,000 person-years (95% confidence interval [CI] 26.8 to 60.4). The incidence was significantly different between the initially normoglycemic patients (11.5%, 95% CI 2.3% to 31.8%) and the prediabetic patients (70.5%, 95% CI 42.7% to 98.3%; p <0.001). A risk model that included the glucose level 2 hours after challenge, glycosylated hemoglobin and triglyceride levels, and presence of noncoronary vascular disease showed good predictive capacity for incident DM (area under the curve 0.882, 95% CI 0.819 to 0.946; p <0.0001). In conclusion, the real incidence of new DM is very high in the coronary population, especially in those with prediabetes. It is necessary to use the OGTT for diagnosis, but we can optimize its indication using a risk model.
      To read this article in full you will need to make a payment

      References

        • Hardoon S.L.
        • Morris R.W.
        • Thomas M.C.
        • Wannamethee S.G.
        • Lennon L.T.
        • Whincup P.H.
        Is the recent rise in type 2 diabetes incidence from 1984 to 2007 explained by the trend in increasing BMI? Evidence from a prospective study of British men.
        Diabetes Care. 2010; 33: 1494-1496
        • Wild S.
        • Roglic G.
        • Green A.
        • Sicree R.
        • King H.
        Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
        Diabetes Care. 2004; 27: 1047-1053
        • Soriguer F.
        • Goday A.
        • Bosch-Comas A.
        • Bordiú E.
        • Calle-Pascual A.
        • Carmena R.
        • Casamitjana R.
        • Castaño L.
        • Castell C.
        • Catalá M.
        • Delgado E.
        • Franch J.
        • Gaztambide S.
        • Girbés J.
        • Gomis R.
        • Gutiérrez G.
        • López-Alba A.
        • Martínez-Larrad M.T.
        • Menéndez E.
        • Mora-Peces I.
        • Ortega E.
        • Pascual-Manich G.
        • Rojo-Martínez G.
        • Serrano-Rios M.
        • Valdés S.
        • Vázquez J.A.
        • Vendrell J.
        Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] Study.
        Diabetologia. 2012; 55: 88-93
        • Magliano D.J.
        • Barr E.L.M.
        • Zimmet P.Z.
        • Cameron A.J.
        • Dunstan D.W.
        • Colagiuri S.
        • Jolley D.
        • Owen N.
        • Phillips P.
        • Tapp R.J.
        • Welborn T.A.
        • Shaw J.E.
        Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes, Obesity and Lifestyle Study.
        Diabetes Care. 2008; 31: 267-272
        • Valdés S.
        • Botas P.
        • Delgado E.
        • Alvarez F.
        • Cadórniga F.D.
        Population-based incidence of type 2 diabetes in northern Spain: the Asturias Study.
        Diabetes Care. 2007; 30: 2258-2263
        • Bartnik M.
        • Rydén L.
        • Ferrari R.
        • Malmberg K.
        • Pyörälä K.
        • Simoons M.
        • Standl E.
        • Soler-Soler J.
        • Ohrvik J.
        Euro Heart Survey on Diabetes and the Heart. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe.
        Eur Heart J. 2004; 25: 1880-1890
        • de la Hera J.M.
        • Delgado E.
        • Hernández E.
        • García-Ruiz J.M.
        • Vegas J.M.
        • Avanzas P.
        • Lozano I.
        • Barriales-Villa R.
        • Hevia S.
        • Martín J.S.
        • Alvarez F.
        • Morís C.
        Prevalence and outcome of newly detected diabetes in patients who undergo percutaneous coronary intervention.
        Eur Heart J. 2009; 30: 2614-2621
        • Hu D.-Y.
        • Pan C.-Y.
        • Yu J.-M.
        The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart survey.
        Eur Heart J. 2006; 27: 2573-2579
        • Norhammar A.
        • Tenerz A.
        • Nilsson G.
        • Hamsten A.
        • Efendíc S.
        • Rydén L.
        • Malmberg K.
        Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study.
        Lancet. 2002; 359: 2140-2144
        • Meisinger C.
        • Beck J.
        • Heier M.
        • Hörmann A.
        • Kuch B.
        • Sietas G.
        • Koenig W.
        Myocardial infarction and incidence of type 2 diabetes mellitus: is admission blood glucose an independent predictor for future type 2 diabetes mellitus?.
        Am Heart J. 2010; 159: 258-263
        • Mozaffarian D.
        • Marfisi R.
        • Levantesi G.
        • Silletta M.G.
        • Tavazzi L.
        • Tognoni G.
        • Valagussa F.
        • Marchioli R.
        Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors.
        Lancet. 2007; 370: 667-675
        • Pajunen P.
        • Koukkunen H.
        • Ketonen M.
        • Jerkkola T.
        • Immonen-Räihä P.
        • Kärjä-Koskenkari P.
        • Mähönen M.
        • Niemelä M.
        • Kuulasmaa K.
        • Palomäki P.
        • Mustonen J.
        • Lehtonen A.
        • Arstila M.
        • Vuorenmaa T.
        • Lehto S.
        • Miettinen H.
        • Juolevi A.
        • Torppa J.
        • Tuomilehto J.
        • Kesäniemi Y.A.
        • Pyörälä K.
        • Salomaa V.
        Five-year risk of developing clinical diabetes after first myocardial infarction: the FINAMI study.
        Diabet Med. 2005; 22: 1334-1337
        • Rydén L.
        • Standl E.
        • Bartnik M.
        • Van den Berghe G.
        • Betteridge J.
        • de Boer M.-J.
        • Cosentino F.
        • Jönsson B.
        • Laakso M.
        • Malmberg K.
        • Priori S.
        • Ostergren J.
        • Tuomilehto J.
        • Thrainsdottir I.
        • Vanhorebeek I.
        • Stramba-Badiale M.
        • Lindgren P.
        • Qiao Q.
        • Priori S.G.
        • Blanc J.-J.
        • Budaj A.
        • Camm J.
        • Dean V.
        • Deckers J.
        • Dickstein K.
        • Lekakis J.
        • McGregor K.
        • Metra M.
        • Morais J.
        • Osterspey A.
        • Tamargo J.
        • Zamorano J.L.
        • Deckers J.W.
        • Bertrand M.
        • Charbonnel B.
        • Erdmann E.
        • Ferrannini E.
        • Flyvbjerg A.
        • Gohlke H.
        • Juanatey J.R.G.
        • Graham I.
        • Monteiro P.F.
        • Parhofer K.
        • Pyörälä K.
        • Raz I.
        • Schernthaner G.
        • Volpe M.
        • Wood D.
        Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: the Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD).
        Eur Heart J. 2007; 28: 88-136
        • Drozda J.
        • Messer J.V.
        • Spertus J.
        • Abramowitz B.
        • Alexander K.
        • Beam C.T.
        • Bonow R.O.
        • Burkiewicz J.S.
        • Crouch M.
        • Goff D.C.
        • Hellman R.
        • James T.
        • King M.L.
        • Machado E.A.
        • Ortiz E.
        • O'Toole M.
        • Persell S.D.
        • Pines J.M.
        • Rybicki F.J.
        • Sadwin L.B.
        • Sikkema J.D.
        • Smith P.K.
        • Torcson P.J.
        • Wong J.B.
        ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association.
        JACC. 2011; 58: 316-336
      1. Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2010; 33: S62-S69
        • Alberti K.G.
        • Zimmet P.Z.
        Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
        Diabet Med. 1998; 15: 539-553
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • Naylor B.A.
        • Treacher D.F.
        • Turner R.C.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Hoelzel W.
        • Weykamp C.
        • Jeppsson J.-O.
        • Miedema K.
        • Barr J.R.
        • Goodall I.
        • Hoshino T.
        • John W.G.
        • Kobold U.
        • Little R.
        • Mosca A.
        • Mauri P.
        • Paroni R.
        • Susanto F.
        • Takei I.
        • Thienpont L.
        • Umemoto M.
        • Wiedmeyer H.-M.
        IFCC reference system for measurement of hemoglobin A1c in human blood and the national standardization schemes in the United States, Japan, and Sweden: a method-comparison study.
        Clin Chem. 2004; 50: 166-174
        • de la Hera J.M.
        • Vegas J.M.
        • Hernández E.
        • Lozano I.
        • García-Ruiz J.M.
        • Fernández-Cimadevilla O.C.
        • Carro A.
        • Avanzas P.
        • Torres F.
        • Bayón J.
        • Menéndez T.
        • Jiménez-Navarro M.
        • Delgado E.
        Performance of glycated hemoglobin and a risk model for detection of unknown diabetes in coronary patients.
        Rev Esp Cardiol. 2011; 64: 759-765
        • Seshasai S.R.K.
        • Kaptoge S.
        • Thompson A.
        • Di Angelantonio E.
        • Gao P.
        • Sarwar N.
        • Whincup P.H.
        • Mukamal K.J.
        • Gillum R.F.
        • Holme I.
        • Njølstad I.
        • Fletcher A.
        • Nilsson P.
        • Lewington S.
        • Collins R.
        • Gudnason V.
        • Thompson S.G.
        • Sattar N.
        • Selvin E.
        • Hu F.B.
        • Danesh J.
        Diabetes mellitus, fasting glucose, and risk of cause-specific death.
        N Engl J Med. 2011; 364: 829-841
        • Selvin E.
        • Steffes M.W.
        • Zhu H.
        • Matsushita K.
        • Wagenknecht L.
        • Pankow J.
        • Coresh J.
        • Brancati F.L.
        Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults.
        N Engl J Med. 2010; 362: 800-811
        • Zhang X.
        • Gregg E.W.
        • Williamson D.F.
        • Barker L.E.
        • Thomas W.
        • Bullard K.M.
        • Imperatore G.
        • Williams D.E.
        • Albright A.L.
        A1c level and future risk of diabetes: a systematic review.
        Diabetes Care. 2010; 33: 1665-1673
        • Ford E.S.
        • Li C.
        • Sattar N.
        Metabolic syndrome and incident diabetes: current state of the evidence.
        Diabetes Care. 2008; 31: 1898-1904
        • Noble D.
        • Mathur R.
        • Dent T.
        • Meads C.
        • Greenhalgh T.
        Risk models and scores for type 2 diabetes: systematic review.
        BMJ. 2011; 343: d7163
        • Lindström J.
        • Absetz P.
        • Hemiö K.
        • Peltomäki P.
        • Peltonen M.
        Reducing the risk of type 2 diabetes with nutrition and physical activity—efficacy and implementation of lifestyle interventions in Finland.
        Public Health Nutrition. 2010; 13: 993-999
      2. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS.
        Diabetes Care. 2012; 35: 723-730
      3. Long-term safety, tolerability, and weight loss associated with metformin in the diabetes prevention program outcomes study.
        Diabetes Care. 2012; 35: 731-737
        • McMurray J.J.
        • Holman R.R.
        • Haffner S.M.
        • Bethel M.A.
        • Holzhauer B.
        • Hua T.A.
        • Belenkov Y.
        • Boolell M.
        • Buse J.B.
        • Buckley B.M.
        • Chacra A.R.
        • Chiang F.-T.
        • Charbonnel B.
        • Chow C.-C.
        • Davies M.J.
        • Deedwania P.
        • Diem P.
        • Einhorn D.
        • Fonseca V.
        • Fulcher G.R.
        • Gaciong Z.
        • Gaztambide S.
        • Giles T.
        • Horton E.
        • Ilkova H.
        • Jenssen T.
        • Kahn S.E.
        • Krum H.
        • Laakso M.
        • Leiter L.A.
        • Levitt N.S.
        • Mareev V.
        • Martinez F.
        • Masson C.
        • Mazzone T.
        • Meaney E.
        • Nesto R.
        • Pan C.
        • Prager R.
        • Raptis S.A.
        • Rutten G.E.H.M.
        • Sandstroem H.
        • Schaper F.
        • Scheen A.
        • Schmitz O.
        • Sinay I.
        • Soska V.
        • Stender S.
        • Tamás G.
        • Tognoni G.
        • Tuomilehto J.
        • Villamil A.S.
        • Vozár J.
        • Califf R.M.
        Effect of valsartan on the incidence of diabetes and cardiovascular events.
        N Engl J Med. 2010; 362: 1477-1490
        • Barzilay J.I.
        • Davis B.R.
        • Cutler J.A.
        • Pressel S.L.
        • Whelton P.K.
        • Basile J.
        • Margolis K.L.
        • Ong S.T.
        • Sadler L.S.
        • Summerson J.
        Fasting glucose levels and incident diabetes mellitus in older nondiabetic adults randomized to receive 3 different classes of antihypertensive treatment: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
        Arch Intern Med. 2006; 166: 2191-2201