Outpatient follow-up of patients with myocardial infarction and early carbohydrate metabolism disorders

Aim. To assess the quality of treatment of patients with myocardial infarction (MI) and early carbohydrate metabolism disorders as part of outpatient follow-up.

Material and methods. The study was conducted within the outpatient registry of patients after myocardial infarction PROFILE-MI, which included all patients who visited a cardiologist at Moscow City  Polyclinic № 9 after myocardial infarction from March 1, 2014 to June 30, 2015. A total of 160 people were included as follows: 106 (66,2%) men and 54 (33,8%) women; mean age, 70,4±10,8 (from 39 to 87) years. Visits were carried out every 2 months. Fasting plasma glucose levels were assessed. The follow-up lasted 1 year. Patients with carbohydrate metabolism disorders 68 (42,5%) were divided into 3 following groups: 1: patients with a history of type 2 diabetes (T2D) or diagnosed at the inpatient stage — 45 (28%); 2: patients with a history of impaired glucose tolerance (IGT) or diagnosed at the inpatient stage — 6 (4%); 3: patients without T2D or IGT (n=109), in whom impaired fasting glycemia was recorded for the first time at the outpatient stage — 17 (16%). The prescription rate of metformin was assessed in all groups.

Results. There were 23 (14,4%) patients with early carbohydrate metabolism disorders included in the registry. In group 3, there were significantly more men than in groups 1 and 2 — 76,5 vs 42 and 33% (p<0,001), and the mean age of 59,8±11,9 years was lower — 64,04±11,4 and 72,5±6,8 years (p=0,033), respectively. In this group, there were no smoking patients (p=0,007), fewer obese patients (18 vs 44 and 33%), but more overweight individuals compared to group 1 (47 vs 40%). In addition, burdened heredity (47 vs 64 and 67%), hypertension (65 vs 84 and 100%) were less frequently registered, respectively. The proportion of patients with a history of coronary artery disease was lower in group 3 compared to group 1 and amounted to 29 vs 47% (p=0,012). During the follow-up period, the prevalence of blood glucose testing did not exceed 44%. Metformin was prescribed only to patients of group 1 upon discharge from the hospital — 3 (6,7%), while metformin therapy was not prescribed to patients of groups 2 and 3. 

Conclusion. According to the PROFILE-MI registry, the total prevalence of early carbohydrate metabolism disorders among patients with a history of MI was quite high and amounted to 14,4%. This category of patients had a less complicated cardiovascular history. In real-world practice, metformin was not prescribed to patients with early carbohydrate metabolism disorders.

1. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi:10.1016/j.diabres.2021.109119.

2. Tabák AG, Herder C, Rathmann W, et al. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379(9833):2279-90. doi:10.1016/S0140-6736(12)60283-9.

3. Weir GC, Bonner-¬Weir S. Five stages of evolving beta-cell dysfunction during progression to diabetes. Diabetes. 2004;53 Suppl 3:S16-21. doi:10.2337/diabetes.53.suppl_3.s16.

4. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S13-27. doi:10.2337/dc18-S002.

5. Aschner P. New IDF clinical practice recommendations for managing type 2 diabetes in primary care. Diabetes Res Clin Pract. 2017;132:169-70. doi:10.1016/j.diabres.2017.09.002.

6. Dedov II, Shestakova MV, Galstyan GR. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Mellitus. 2016;19(2):104-12. (In Russ.) doi:10.14341/DM2004116-17.

7. Dedov II, Shestakova MV, Vikulova OК. National register of diabetes mellitus in Russian Federation: Status on 2014. Diabetes Mellitus. 2015;18(3):5-22. (In Russ.) doi:10.14341/DM201535-22.

8. Liang Y, Wang M, Wang C, et al. The Mechanisms of the Development of Atherosclerosis in Prediabetes. Int J Mol Sci. 2021; 22(8):4108. doi:10.3390/ijms22084108.

9. Cai X, Zhang Y, Li M, et al. Association between prediabetes and risk of all cause mortality and cardiovascular disease: Updated meta-analysis. BMJ. 2020;370:m2297. doi:10.1136/bmj.m2297.

10. Rydén L, Grant PJ, Anker SD, et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD — summary. Diab Vasc Dis Res. 2014; 11(3):133-73. doi:10.1177/1479164114525548.

11. Unwin N, Shaw J, Zimmet P, et al. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med. 2002;19(9):708-23. doi:10.1046/j.1464-5491.2002.00835.x.

12. Beulens J, Rutters F, Rydén L, et al. Risk and management of pre-diabetes. Eur J Prev Cardiol. 2019;26(2_suppl):47-54. doi:10.1177/2047487319880041.

13. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;34 Suppl 1(Suppl 1):S62-9. doi:10.2337/dc11-S062.

14. Cosentino F, Grant PJ, Aboyans V, et al. ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. doi:10.1093/eurheartj/ehz486.

15. Dedov II, Shestakova MV, Mayorov AY, et al. Diabetes mellitus type 2 in adults. Diabetes mellitus. 2020;23(2S):4-102. (In Russ.) doi:10.14341/DM12507.

16. Martsevich SYu, Kutishenko NР, Sichinava DР, et al. Prospective outpatient registry of myocardial infarction patients (PROFILE-MI): Study design and first results. Cardiovascular Therapy and Prevention. 2018;17(1):81-6. (In Russ.) doi:10.15829/1728-8800-2018-1-81-86.

17. Norhammar A, Tenerz A, Nilsson G, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359(9324):2140-4. doi:10.1016/S0140-6736(02)09089-X.

18. Chazova IE, Shestakova МV, Zhernakova YuV, et al. Eurasian association of cardiology guidelines for the prevention and treatment of cardiovascular diseases in patients with diabetes and prediabetes (2021). Eurasian Guidelines for the prevention and treatment of cardiovascular diseases in patients with dia¬betes and prediabetes (2021). Eurasian Heart J. 2021;(2):6-61. (In Russ.) doi:10.38109/2225-1685-2021-2-6-61.

19. Joseph JJ, Deedwania P, Acharya T, et al. American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; and Council on Hypertension. Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association. Circulation. 2022;145(9):e722-59. doi:10.1161/CIR.0000000000001040.

20. Lindström J, Louheranta A, Mannelin M, Rastas M. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26:3230-6. doi:10.2337/diacare.26.12.3230.

21. Diabetes Prevention Program (DPP) Research Group. The Dia¬betes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002;25:216571. doi:10.2337/diacare.25.12.2165.

22. Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium. Circulation. 2017;136:52-64. doi:10.1161/CIRCULATIONAHA.116.025483.

23. Ushanova FО, Demidova TYu. Prediabetes: independent di¬sease or cardiovascular risk factor? FOCUS Endocrinology. 2020;(1):27-35. (In Russ.) doi:10.47407/ef2020.1.1.0004.

24. Kochergina II. Self-monitoring of blood glucose in patients with diabetes and cardiac pathology with the Meter Contour TS use. Cardiosomatics. 2014;5(3-4):14-9. (In Russ.)

25. Look AHEAD Research Group. Wing R, Bolin P, Brancati F. Cardio-vascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-54. doi:10.1056/NEJMoa1212914.