Joseph Azzopardi

The prognostic value of blood glucose in diabetic patients with acute myocardial infarction.

The aim of the study was to investigate prospectively the prognostic value of blood glucose on admission in diabetic and non‐diabetic patients with an acute myocardial infarction. Three hundred and thirty‐three diabetic and 565 non‐diabetic patients were admitted with acute myocardial infarction during the study period of 3.5 years. There was a significant association between mortality and blood glucose on admission in diabetic patients (regression coefficient, r=0.92, 0.5

Factors That Influence Outcome in Diabetic Subjects With Myocardial Infarction

OBJECTIVE To compare the outcome of acute myocardial infarction in NIDDM patients and nondiabetic control subjects. The relation of glycemic control, duration of diabetes, and major diabetic complications to the outcome of acute myocardial infarction in diabetic subjects was investigated. RESEARCH DESIGN AND METHODS This was a prospective, hospitalbased, case-control study. RESULTS One hundred and ninety-six NIDDM patients and 196 nondiabetic control subjects with acute myocardial infarction were entered into the study: 23.5% of diabetic subjects and 34.2% of control subjects received thrombolytic therapy (P < 0.05). Diabetic subjects showed signs of reperfusion less often than control subjects (P < 0.05). Mortality was higher in the diabetic group (17.3 vs. 10.2%, P < 0.05). Pump failure (38.3 vs. 16.8%, P < 0.01) and cardiogenic shock (9.7 vs. 3.6%, P < 0.05) also occurred more frequently in diabetic subjects. Loss of heart rate variability was correlated with both pump failure and mortality; proliferative retinopathy was correlated with pump failure. Glycemic control and other diabetic complications did not correlate with outcome. CONCLUSIONS Our findings confirm the higher mortality and incidence of pump failure in acute myocardial infarction with co-morbid diabetes. They suggest that the less frequent use of thrombolytic therapy, lower reperfusion rates, and more advanced coronary artery disease might be contributory. The presence of autonomic neuropathy and microvascular disease probably also contribute to poor outcome; other major diabetic complications and diabetic control did not influence outcome.

Outcome of Unstable Angina in Patients with Diabetes Mellitus

This prospective hospital‐based, case–control study compares the outcome of unstable angina in non‐insulin dependent diabetic patients and non‐diabetic control subjects. One hundred and sixty‐two diabetic patients and 162 non‐diabetic control patients with unstable angina were entered into the study. The 3‐month mortality was 8.6 % (95 % confidence interval, CI = 4.4–12.9 %) in diabetic patients and 2.5 % (CI = 0.1–4.9 %) in control patients (p = 0.014). The 1‐year mortality was 16.7 % (CI = 10.9 %–22.4 %) in diabetic patients and 8.6 % (CI = 4.4 %–12.9 %) in non‐diabetic patients (p = 0.029). Diabetic patients received beta‐blockade and underwent coronary angiography and angioplasty less frequently than controls; the frequency of unstable angina, of acute myocardial infarction, and of coronary artery bypass grafting was similar in both groups at 1 year of follow‐up. It is concluded that diabetic patients with unstable angina have a higher mortality than non‐diabetic patients and that this difference is largely accounted for by early (first 3 months) mortality.

Absence of circadian variation in the onset of acute myocardial infarction in diabetic subjects.

OBJECTIVES--To investigate the circadian pattern of acute myocardial infarction in non-insulin-dependent diabetic patients and to compare it with that of controls. BACKGROUND--Previous studies have shown that there is a circadian variation in the incidence of acute myocardial infarction, but there are few data on diabetic subjects. METHODS--A hospital based prospective case-control study. RESULTS--196 diabetic patients and 196 age and sex matched controls were admitted with a diagnosis of acute myocardial infarction during the study period. IN 32 diabetic patients and 38 controls, the time of onset of myocardial infarction was unknown; in 34, 44, 42, and 44 diabetic patients the onset was in the first to fourth quarters respectively (chi 2 = 1.66, NS). The corresponding figures for the controls were 30, 56, 45, and 27 (chi 2 = 13.9, P < 0.005). The difference between the two groups was highly significant (chi 2 = 10.3, P < 0.025). CONCLUSIONS--Diabetic subjects do not show a significant circadian variation in the onset of acute myocardial infarction.

Increased prevalence of proteinuria in diabetic sibs of proteinuric type 2 diabetic subjects

There is strong evidence for clustering of renal disease in type 1 diabetes, but few data exist with respect to type 2 diabetes. The objective of this case-control study is to determine whether there is a familial predisposition to the development of proteinuria in patients with type 2 diabetes. Fifty patients with type 2 diabetes with macroproteinuria (protein > or = 500 mg/24 h) with no evidence of causes other than diabetic nephropathy on investigation were identified through routine screening. These patients had 25 living sibs with diabetes, of whom 24 sibs agreed to participate on the study. For each of these sibs, two controls with non-insulin-dependent diabetes were randomly selected, individually matched for age, sex, and duration of diabetes. Twelve of 24 sibs (50%) and 9 of 48 controls (18.8%) had proteinuria (P < 0.01). Systolic and diastolic blood pressure and the proportion on antihypertensive treatment were similar in the two groups. Our data suggest there is increased prevalence of macroproteinuria in diabetic sibs of macroproteinuric patients with type 2 diabetes in a population of white, Caucasian, European descent.

Lack of evidence of cerebral oedema in adults treated for diabetic ketoacidosis with fluids of different tonicity

Each of ten adult patients consecutively admitted in DKA (diabetic ketoacidosis) was infused with either 0.15 or 0.12 mol/l saline as part of the treatment regimen. Computerized tomography (CT) scans of the brain were performed before treatment, and at 6-12 and 24 h together with a number of blood variables. The CT scans of a group of ten patients with no history of diabetes were studied as controls. The CT scans of all diabetic patients in DKA showed a definite increase in brain tissue density when compared with those of non-diabetic subjects (mean 36.2 vs. 28.9 Hounsfield units (HU), P<0.001). This did not change with either fluid regimen over the first 24 h. There was a statistically significant difference in brain tissue density between the CT scans of patients in DKA compared with CT scans taken >6 months after the last episode of DKA (32.6 vs. 25.4 HU, P<0.001). The CT scans taken >6 months after the last episode of DKA showed normal brain tissue density with no statistically significant differences from those of control scans. The density of diabetic brains on CT scanning during ketoacidosis is increased; this may be due to cerebral dehydration. This paper does not provide any evidence of cerebral oedema in adults during the treatment of ketoacidosis with isotonic and hypotonic fluids.

Circadian variation in the onset of acute pulmonary edema and associated acute myocardial infarction in diabetic and nondiabetic patients.

It is known that most acute cardiovascular events exhibit a circadian rhythm in their onset. The authors describe differences in the circadian rhythm of onset of acute pulmonary edema and associated acute myocardial infarction in diabetic and nondiabetic patients.

Thrombolysis in patients with diabetes. Risk of intraocular haemorrhage remains unknown.

EDITOR,—Helen Ward and John S Yudkin conclude that thrombolysis should not be withheld in diabetic patients with retinopathy.1 We have shown that diabetic subjects are less likely to receive this treatment than non-diabetic controls.2 The authors note that there has been only …

Thrombolysis in diabetic patients with myocardial infarction.

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