TY - JOUR
T1 - Stress hyperglycemia : a prospective study examining the relationship between glucose, cortisol and diabetes in myocardial infarction
AU - Cheung, N. Wah
AU - Wong, K. Y. Carmen
AU - Kovoor, Pramesh
AU - McLean, Mark
PY - 2019
Y1 - 2019
N2 - Aim: We aimed to explore the relationship between stress, hyperglycemia and diabetes in myocardial infarction (MI), using serum cortisol as a surrogate marker for the severity of stress. Methods: Subjects with acute MI were prospectively recruited upon hospital admission. Serum glucose and cortisol were measured in addition to standard testing. Subjects were defined as having stress hyperglycemia (SH) if they had an admission glucose ≥7.8 mmol/L without a history of glucose intolerance. Subjects were followed up with glucose tolerance testing post-discharge. Results: Of the 200 subjects in the study, 58 had known diabetes/impaired glucose tolerance (IGT), and 45 had SH. There was a positive association between admission glucose and cortisol for the entire cohort (rs = 0.26, p < 0.01). This relationship was present in the subgroup who had SH and then normal glucose post-discharge (rs = 0.53, p = 0.03), but not in SH subjects who had diabetes/IGT on post-discharge testing. It was also evident amongst all subjects with normal glucose (rs = 0.46, p < 0.01), but not those with diabetes/IGT in general. On multivariate analysis, admission glucose was a positive predictor and cortisol a negative predictor of abnormal glucose tolerance. Conclusions: Our data suggests that SH with MI reflects either underlying glucose intolerance or more severe stress in people without glucose intolerance.
AB - Aim: We aimed to explore the relationship between stress, hyperglycemia and diabetes in myocardial infarction (MI), using serum cortisol as a surrogate marker for the severity of stress. Methods: Subjects with acute MI were prospectively recruited upon hospital admission. Serum glucose and cortisol were measured in addition to standard testing. Subjects were defined as having stress hyperglycemia (SH) if they had an admission glucose ≥7.8 mmol/L without a history of glucose intolerance. Subjects were followed up with glucose tolerance testing post-discharge. Results: Of the 200 subjects in the study, 58 had known diabetes/impaired glucose tolerance (IGT), and 45 had SH. There was a positive association between admission glucose and cortisol for the entire cohort (rs = 0.26, p < 0.01). This relationship was present in the subgroup who had SH and then normal glucose post-discharge (rs = 0.53, p = 0.03), but not in SH subjects who had diabetes/IGT on post-discharge testing. It was also evident amongst all subjects with normal glucose (rs = 0.46, p < 0.01), but not those with diabetes/IGT in general. On multivariate analysis, admission glucose was a positive predictor and cortisol a negative predictor of abnormal glucose tolerance. Conclusions: Our data suggests that SH with MI reflects either underlying glucose intolerance or more severe stress in people without glucose intolerance.
KW - diabetes
KW - hydrocortisone
KW - hyperglycemia
KW - myocardial infarction
KW - stress (psychology)
UR - http://handle.westernsydney.edu.au:8081/1959.7/uws:51157
U2 - 10.1016/j.jdiacomp.2018.12.015
DO - 10.1016/j.jdiacomp.2018.12.015
M3 - Article
SN - 1056-8727
VL - 33
SP - 329
EP - 334
JO - Journal of Diabetes and Its Complications
JF - Journal of Diabetes and Its Complications
IS - 4
ER -