Abstract 12373: Impairment of Insulin Secretion but not Insulin Resistance is Associated with Glucose Abnormality in Patients with Acute Coronary Syndrome

Abstract

Background: Glucose abnormalities observed during the acute phase of acute coronary syndrome (ACS) increase the risk of adverse outcomes; however, the underlying mechanism for the glucose abnormality in ACS patients has not been fully evaluated. In our study, we evaluated the time course of insulin secretion and glucose intolerance in ACS patients.

Methods and results: 26 patients with ACS (20 AMI, 6 UAP) without history of diabetes mellitus were examined in this study (71 years, 21 male). Patients with congestive heart failure or cardiogenic shock were excluded from this study. Glucose intolerance test (OGTT) was performed in acute phase (3 days after admission) and in subacute phase (1 week after admission). Insulin resistance was assessed by HOMA-R. Early phase insulin secretion was assessed by insulinogenic index. High prevalence of glucose intolerance was found in acute phase (DM 46%, IGT 42%, NGT 12%). Patients with DM had lower insulinogenic index compared with patients with IGT or NGT (p<0.05). In all cases, insulinogenic index significantly improved from acute phase to subacute phase (0.5+/-0.5 to 0.9+/-0.8, p<0.01); whereas there was no change in HOMA-R.

Conclusion: We found that an impaired insulin secretion mainly accounts for glucose intolerance in ACS patients. It is also suggested that early OGTT can identify patients with DM, allowing a more appropriate treatment to be established.