Arjun, J (2023) An Analytical Cross-Sectional Study to Determine the Effect of Glycemic Gap as a Biomarker of Severity and Outcome among Acute Myocardial Infarction Patients with Type 2 Diabetes Mellitus in a Tertiary Care Centre in Chennai. Masters thesis, Stanley Medical College, Chennai.
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Abstract
BACKGROUND: Hyperglycemia is a common observation in acute myocardial infarction patients presenting to the emergency department. Stress Induced Hyperglycemia (SIH) is an acute response that has been associated with adverse outcomes in many critical illnesses including acute myocardial infarction. The Admission Blood Glucose (ABG) level may not be a true reflector of the stress-induced rise in blood glucose levels, as it can be influenced by the underlying glycaemic status of patients with diabetes mellitus. Recently, glycemic gap has emerged as a novel glycemic indicator and is defined as the difference between the ABG and ADAG (i.e. A1c Derived Average Glucose which is the estimated three month average blood sugar value derived from the HbA1c using the formula eAG = 28.7 × HbA1c–46.7). The glycemic gap has been studied in various critical illnesses such as community acquired pneumonia, sepsis, acute ischaemic stroke and intracranial haemorrhage but studies in acute MI are very few in number. OBJECTIVES: To analyse the effect of the glycemic gap on the severity and outcome of Acute Myocardial Infarction in patients with Diabetes Mellitus admitted in a tertiary care centre. MATERIALS AND METHODS: This is a prospective cross-sectional study where 100 diabetes mellitus patients who were admitted with acute myocardial infarction were included in the study. The study spanned over a period of 1 year. The Glycemic gap was calculated for the patients. Patients were classified into two groups based on the glycaemic gap values with one group of patients having a high glycaemic gap and the other group with a low glycaemic gap. The severity of MI and the outcome were assessed in both the groups and compared. RESULTS: Patients with an elevated glycemic gap presented with a higher Killip class and were found to have higher risk of adverse outcomes such as cardiogenic shock, acute respiratory failure, a lower LV ejection fraction, longer duration of hospital stay and higher mortality rate when compared to those with a low glycemic gap. CONCLUSION: The glycemic gap is superior to admission CBG as well as HbA1c values in predicting mortality in patients with acute MI. The glycemic gap thus provides additional prognostic information beyond that provided by conventional risk factors in diabetic patients presenting with acute MI.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | Reg.No.200120101003 |
| Uncontrolled Keywords: | Acute MI, Stress Induced Hyperglycemia, Glycemic gap. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Thavamani K |
| Date Deposited: | 24 May 2022 00:44 |
| Last Modified: | 20 Mar 2024 04:38 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/20140 |
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