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Many studies have confirmed the negative impact of hyperglycemia on admission on the prognosis during early stages of acute coronary syndroms for both diabetic and non-diabetic patients. But fewer have established a relation between this hyperglycemia and the diagnosis of new cases of diabetes. In fact, admission hyperglycemia can be the reflect of either an unknown diabetes, a hyperglycemia related to stress or a combination of those two situations. The objective of this study was to determinate the prevalence of type 2 Diabetes Mellitus following a STEMI among a population of patients without a prior history of diabetes. And analyze the relationship between hyperglycemia on admission and diagnosis of new cases of diabetes in a population of STEMI without a history of diabetes
We conducted a prospective multicenter cohort study of 1418 non diabetic patients admitted during the acute phase of a STEMI during a period of 15 months. All patients benefited from a blood glucose test at admission to hospital and glycated hemoglobin (HbA1c) test for the diagnosis of new cases of type 2 Diabetes Mellitus
The prevalence of undiagnosed diabetes among non diabetic patients admitted during the early stage of STEMI was 13.8% For the glycemia on admission and with a cutoff of 1.70g/l appears to be a descriminating test for the prediction of newly diagnosed diabetes during hospitalization for ACS (AUC=0,965 CI 95% [0,954 - 0,977]) the Sensitivity was 96,4% (CI 95% [92,6 - 98,4]) and Specificity 82,6% (CI 95% [80,384,6]),a PPV of 47% and above all an excellent NPV of 99,3%.
Type 2 Diabetes Mellitus is common among patients with ACS. Its screening should be done ideally through the assesment of glycated hemoglobin level. Admission Glycemia can represent a early and simple way for selecting patients at high risk to have an undiagnosed diabetes and thus we can in a second stage propose to them a screening the HbA1c blood test.