Type 2 Diabetes and Acute Myocardial Infarction

• The prevalence of abnormal glucose regulation defined by an oral glucose tolerance test (OGTT). [ Time Frame: Three-months after an acute ST-elevation myocardial infarction (STEMI). ] [ Designated as safety issue: No ]
  

• Validate the results of an OGTT performed early after myocardial infarction, [ Time Frame: Repeating the test after three months. ] [ Designated as safety issue: No ]
  
• Elucidate possible interactions between biomarkers of inflammation and haemostasis, and the glucometabolic status. [ Time Frame: Three months ] [ Designated as safety issue: No ]
  
• Study the relationship between abnormal glucose regulation and prognosis after STEMI. [ Time Frame: Two years ] [ Designated as safety issue: No ]
  

Background: A high prevalence of impaired glucose tolerance (IGT) and unknown diabetes mellitus (DM) in patients with cardiovascular disease has been shown. European guidelines recommend screening of patients with AMI for DM and IGT by performing an oral glucose tolerance test (OGTT). The prevalence of IGT and DM in a Norwegian population of patients with AMI is unknown. Evidence are lacking regarding the reliability of an OGTT performed early after an AMI. The present study was designed to detect unknown IGT and DM in patients with AMI and the main challenge of the study was timing and reproducibility of the OGTT. In addition, mechanisms (inflammation, haemostasis) involved in impaired glucose regulation will be studied. Design: The study is designed as an observational cohort study prospectively including 200 patients with a primary PCI treated acute STEMI admitted to the coronary care unit at Ullevål university hospital. An OGTT is performed in-hospital and repeated after 3 months and a glucometabolic classification was performed according to the results. The patients will be followed for a minimum of two-years with regards to clinical endpoints.

Aims of the study:

1. Study the prevalence of IGT and DM in a Norwegian population with acute STEMI.
2. Validate the results of an OGTT performed early after myocardial infarction, by repeating the test after three months.
3. Elucidate possible interactions between biomarkers of inflammation and coagulation, and the glucometabolic status.
4. Study the relationship between impaired glucose tolerance and prognosis after STEMI.
5. Contribute to an increased focus on undiagnosed DM and IGT in patients with coronary heart disease in Norway and the results may lead to an increased use of routine OGTT in the follow-up of patients with myocardial infarction. Investigate how patients with myocardial infarction and known glucometabolic state are followed up "in real-life" by their physicians.

Clinical implications: The study may detect a large proportion of undetected DM and IGT in patients with AMI and change present guidelines on the follow-up of patients after AMI with increased focus on impaired glucose tolerance. The study will provide new insights about the association between inflammation, haemostasis and impaired glucose tolerance in patients with acute ST-elevation myocardial infarction.