Chauhan Vinay Singh

Nayak Rashmi

CiteSeerX

 International Research Journal of Medical Sciences ____________________________________ ISSN 2320 –7353 
Vol. 3(6), 1-4, June (2015) Int. Res. J. Medical Sci. 
 
 International Science Congress Association        1 
Glycoslated Haemoglobin as a Diagnostic Marker of Diabetes Mellitus in 
Acute Myocardial Infarction and Correlation with Dietary Pattern 
 
Nayak  Rashmi and Chauhan Vinay Singh 
Department of Pathology, NSCB Medical College, Jabalpur, MP, INDIA 
 
Available online at: www.isca.in, www.isca.me 
Received 1st April 2015, revised 5th June 2015, accepted 20th June 2015 
 
 
 
Abstract  
This study was planned to assess the role of glycosylated hemoglobin as a diagnostic marker to diagnose and treat diabetes 
at earliest in acute myocardial infarction. It is meant to improve the prognosis in patients of acute myocardial infarction.  
Studies also assess any correlation between diabetic status and dietary pattern. This is hospital based cross-sectional study.  
100 patients with acute myocardial infarction admitted to coronary care units, during October 2013 to September 2014 were 
studied .Patients during admission blood glucose >140mg/dl with no past history of diabetes mellitus were included in the 
study. Serum blood glucose and HbA1c were estimated at admission. History and examination carried out. Detailed history 
about their dietary pattern was taken. These patients were followed up after 15 days to assess their blood glucose. Their 
diabetic status was confirmed as per WHO criteria. Data were analyzed using SPSS-20 software. Out of 100 patients, 84 
patients had value of HbA1c in the diabetic range (≥6.5%) and 16 patients had HbA1c in the non diabetic range (<6.5%). 
On follow up, out of 84 patients, 75 patients (89.28%) were confirmed to be diabetic according to the WHO criteria. 
Statistically study found highly significant (p<0.0001). Out of 100 patients, 34 cases were non vegetarians and 66 cases were 
vegetarian. In non vegetarians’ 94.1% were found with increased HbA1c level. Statistically this was found significant 
(p<0.05). HbA1c estimation is useful tool and accurate interpretation of hyperglycemia following AMI. HbA1c estimation at 
the time of admission clearly differentiates stress hyperglycemia from hyperglycemia of undiagnosed diabetes mellitus. 
HbA1c is a more sensitive and specific diagnostic marker than blood glucose for diabetes mellitus in patients with MI and 
non vegetarian dietary pattern was found associated with diabetes and cardiovascular disease.     
 
Keywords: Glycosylated hemoglobin, diabetes mellitus, myocardial infarction, hyperglycemia, diet, nonvegitarian. 
 
Introduction 
Diabetes mellitus is a disease of antiquity known to mankind 
since past 3500 years. Now diabetes mellitus becomes the most 
common non communicable, life style associated disease 
worldwide.  India and china are converting in to hub of 
diabetes
1
. Most dreadful part is large number of patients remains 
unrecognized. 
 
It is of great concern because of the devastating effect of its 
complications. Diabetes mellitus has been recognized as a risk 
factor for coronary heart disease since ages
2
. Hyperglycemia is 
associated with large infarct size
3
. Mortality due to coronary 
heart disease is very high in diabetics
4
. Hence early diagnosis 
and control of diabetes mellitus is important. It is to improve the 
prognosis of patients with AMI and to prevent the adverse 
outcome. 
 
 At the time of admission most of the patients of AMI have 
hyperglycemia, are associated with increased risk of morbidity 
and mortality
5
. This hyperglycemia could simply be a marker of 
preexisting, not yet diagnosed diabetes, impaired glucose 
tolerance or may be stress induced hyperglycemia.
 
Blood 
glucose estimation alone is insufficient, unreliable tool and oral 
glucose tolerance test is impractical. 
 
This differentiation is important because any attempt to lower 
stress induced hyperglycemia may cause hypoglycemia leading 
to tachycardia and cause deleterious effects
6
. HbA1c estimation 
provides an average blood glucose level for a period of 8-12 
weeks
7
. HbA1c proves useful for diagnosis of DM in AMI. 
Stress induced hyperglycemia is a confounding factor. HbA1c is 
unlikely to rise with stress induced acute hyperglycemia
8
. 
HbA1c concentration can be used to distinguish stress induced 
hyperglycemia from diabetes mellitus for early appropriate 
treatment to prevent morbidity and mortality. 
 
American diabetes association has clearly described vegetarian 
diet as healthful and least risk of diabetes. Red meat 
consumption has been associated with increased risk of 
diabetes
9
. 
 
Reduced consumption of animal fat and increased consumption 
of fruit, vegetables and food with low level of glycemic index 
such as legumes, nuts, cereals, and whole grain reduce the risk 
of chronic disease and may have protective effect. 
 
Material and Methods 
This study is carried out in Government NSCB Medical 
International Research Journal of Medical Sciences ________________________________________________ ISSN 2320 –7353  
Vol. 3(6), 1-4, June (2015) Int. Res. J. Medical Sci. 
1.  International Science Congress Association            2 
College, Jabalpur.  Department of Pathology and ICCU. 100 
M.I. patients admitted in ICCU during October 2013 to 
September 2014 fulfilling the inclusion criteria. 
 
Inclusion criteria: Patients diagnosed AMI confirmed by 
electrocardiogram or cardiac marker (CPK-MB). Patients not 
known or diagnosed as diabetic. Patients whose admission 
glucose level found >140mg/dl. 
 
Exclusion criteria: Patients died of AMI and its complications 
during hospital stay. Patients unavailable for follow up after 15 
days. 
 
Venous blood was taken at the time of admission for estimation 
of blood sugar and HbA1c before starting treatment. These 
patients were further followed up after 15 days .Their fasting 
blood sugar was estimated. Patients with HbA1c ≥6.5% as cut 
off were analyzed for diabetes as per WHO criteria. 
 
The majority of studies conducted included HbA1c ≥6.5% as 
cut off for diabetic diagnosis as per American Diabetic 
Association and WHO. 
 
Specimen collection and preparation: We need preferentially 
venous blood using EDTA anticoagulant. Reagents should be at 
room temperature. Dilute the sample with lysing reagent in the 
1:100 ratios. Wait for minimum 3 minutes; take care to avoid 
the formation of foam. Erythrocytes are lysed by low osmotic 
pressure. Greenish-brown color develops as per the hemoglobin 
concentration of sample. 
 
HbA1c is determined immunoturbidometrically. The final result 
is expressed as percent HbA1c.  
 
Method and Test principle: Test is based on 
immunoturbidometry performed by auto analyser. It is based on 
interaction between antigen molecule (HbA1c) and HbA1c 
specific monoclonal antibodies coated on latex bead. This cross 
link reaction results in change in the solution turbidity. HbA1c 
was estimated by auto analyser Biosystem S.A. COD 22044.  
 
Advantages: HbA1c is stable after collection of sample. Their 
levels do not fall on storage prior to test. Sample can be 
obtained at any time. It requires no patient’s preparation. Their 
levels do not vary between meals like blood sugar. 
 
Statistical test applied: Statistical analyses were carried out by 
using SPSS 20 software. The results obtained are statistically 
analyzed.  
 
Results and Discussion 
100 patient admitted in ICCU with acute myocardial infarction 
without past history of diabetes mellitus during October 2013 to 
September 2014 was included in the study. All 100 patients had 
admission blood glucose >140mg/dl. Table-1 shows that out of 
100 cases 84 patients had value of HbA1c in the diabetic range 
(>6.5%) and 16 patients had HbA1c in the non-diabetic range 
(<6.5%). On follow up after 15 days, out of 84 patients with 
HbA1c>6.5%, 75 patients (89.28%) were confirmed to be 
diabetic and only 9 patients (10.72%) were found to be non 
diabetic according to WHO criteria. Statistically this was highly 
significant (p<0.0001).  Rest 16 patients with HbA1c<6.5%, 
only 1case (1.3%) was diagnosed as diabetes on blood glucose 
estimation. Sensitivity of the test (HbA1c) in diagnosing 
diabetes in acute myocardial infarction patients was 98.6, 
specificity was 62.5, and positive predictive value 89.28, 
negative predictive value was 93.75. Therefore in the present 
study 75% of patients had previously unrecognized diabetes 
mellitus that had come to light after HbA1c estimation and rest 
25% of patients had admission hyperglycemia that was 
secondary to stress of AMI. 
 
Table-1 
Diabetic status and HbA1c 
- HbA1c <6.5% HbA1c >6.5% 
DM (76) 1(1.3%) 75(98.7%) 
ND (24) 15(62.5%) 9(37.5%) 
Total (100) 16 84 
 
In the present study (table-2) <40yr cohort only 25% case were 
found with increased HbA1c level while in 40-59 yr age group 
85.1% cases and in >60yr age group 87.8% cases were found 
with increased HbA1c level. Statistically a significant 
association of increased age and increased HbA1c level was 
found (p<0.01). This finding is comparable with studies done by 
J. D. Kesqvadev et al
10
 and others
11-13
. 
 
Table-2 
Age and HbA1c 
Age HbA1c <6.5% HbA1c >6.5% Total 
<40yr 3(75.0%) 1(25%) 4 
40-59yr 7(14.9%) 40(85.1%) 47 
>60yr 6(12.2%) 43(87.8%) 49 
 
In the present study (table-3) rural population cohort (46), 
76.1% were having raised HaA1c while in urban population 
(54), 90.7% was having raised HbA1c. This association between 
urban population and HbA1c level was found significant (χ
2
 
=3.969; p<0.05). Study by Baizayanti baur et al
14 
also showed 
similar result. 
 
Table-3 
Habitate and HbA1c 
Habitate HbA1c <6.5% HbA1c >6.5% Total 
Rural 11(23.9%) 35(76.1%) 46 
Urban 5(9.3%) 49(90.7%) 54 
Total 16 84 100 
 
Both rural and urban area in India are currently experiencing a 
great increase in lifestyle oriented diseases. Urban population 
International Research Journal of Medical Sciences ________________________________________________ ISSN 2320 –7353  
Vol. 3(6), 1-4, June (2015) Int. Res. J. Medical Sci. 
1.  International Science Congress Association            3 
have more number of diabetic patients but rural population is 
also at risk for development of diabetes mellitus.  
 
Table-4 shows about the dietary pattern of the subjects. Among 
34 cases with non vegetarian diet, 94.1% case were found with 
increased levels of HbA1c while in vegetarian category (66 
cases) only 78.8% cases were found with raised level of HbA1c. 
Statistically this was significant, showing that cases with non-
vegetarian diet were having higher chances of raised HbA1c 
level (χ
2
 =3.92; p<0.05). The results are consistent with studies of 
Shishir nigam
15
.  Most vegetarian diets are not only nutritionally 
adequate but also associated with lower risk of diabetes and 
cardio vascular disease. Diet rich in fiber and complex 
carbohydrate and restricted in fat improve control of blood 
glucose concentration and aid in good control of diabetes
16
. Non 
vegetarian diets like red meat were associated with increased 
risk of diabetes
17
. 
Table-4 
Dietary habit and HbA1c 
Dietary pattern HbA1c <6.5% HbA1c >6.5% Total 
Non veg 2(5.9%) 32(94.1%) 34 
Veg 14(21.2%) 52(78.8%) 66 
Total 16 84 100 
 
In the present study modifiable risk factors like smoking, 
tobacco, alcohol intake were found more common in diabetic 
patients than non diabetic patients (table-5). Similar 
observations were found in other studies
18,19
. 
 
Conclusion 
Glycosylated hemoglobin estimation is useful for early and 
accurate interpretation of hyperglycemia following acute 
myocardial infarction. HbA1c estimation at the time of 
admission to ICCU clearly and quickly differentiates stress 
induced hyperglycemia in M.I. patients from hyperglycemia in 
undiagnosed diabetic patients with AMI. 
 
HbA1c is more sensitive and specific diagnostic test for diabetes 
mellitus in patients with AMI than serum blood glucose 
Prognosis in cases of AMI improves by early identification of 
diabetic and nondiabetic cases by HbA1c evaluation and 
effective management.  
 
Smoking, alcohol and tobacco consumption predisposes to 
diabetes and acute myocardial infarction. 
 
Non vegetarian dietary pattern was associated with increased 
risk of diabetes and cardio vascular disease. 
 
References 
1. Frank B.Hu, M.D., Ph.D., Globalisation of diabetes, The 
role of diet, lifestyle and gene, American Diabetes 
Association, Diabetes care June, 34, 61249-1257 (2011) 
2. Rev Port Cardiol, Coronary Heart Disease in diabetes 
mellitus risk factor and epidemiology, 23(10) 1359-66 
(2004) 
3. Timmer Jr, Vander Horst ICC, Ottervanger JP, Henriqves 
JPS, Hoornlje JCA and Boer MJ et al, Prognostic value 
of admission glucose in non diabetic patients with 
myocardial infarction, A M Heart J., 148, 399-03 (2004) 
4. Foo K, Cooper J, Deaner A, Knight C, Suliman A and 
Ranjadayalan K et al, A single serum glucose 
measurement predicts adverse outcomes across the whole 
range of acute coronary syndrome, A  J Heart, 89, 512-6 
(2003) 
5. Umpierrez GE, Isaacs SD, Bazargan N, Youx, Thaler 
LM and Kitachi A E et al, Hyperglycemia: An 
independent marker of in hospital mortality in patients 
with undiagnosed diabetes, J Clin Endocrinal Metab., 87, 
978-82 (2002) 
6. Sandeep Chopra and Aditya Kewal, Does hypoglycemia 
cause cardiovascular events?, Indian Journal of 
endocrinology and metabolism, 16(1), 102-104 (2012 ) 
7. American Diabetes Association, Standards of medical 
care in diabetes (position statement) Diabetes care, 27(1), 
515-35 (2004) 
8. Michael Cd’ Emden, the role of HbA1c in the diagnosis 
of diabetes mellitus in Australia, Med J Aust, 197(4), 
220-221 (2012) 
 
Table-5 
Association between HbA1c, and smoking, alcohol and  tobacco consumption 
Characteristics 
HbA1c 
Value 2 value P value 95%confidence interval 
<6.5% >6.5% 
Tobacco chewing 
Present 5 49 
3.37 <0.05 -.521227 -.020438 
Absent 11 35 
Smoking 
Present 6 54 
4.02 <0.05 -.526258 -.009456 
Absent 10 30 
Alcohol intake 
Present 2 35 
4.90 <0.05 -.484993 -.098339 
Absent 14 49 
International Research Journal of Medical Sciences ________________________________________________ ISSN 2320 –7353  
Vol. 3(6), 1-4, June (2015) Int. Res. J. Medical Sci. 
2.  International Science Congress Association            4 
9. American Dietetic Association; Dietitians of Canada: 
Position of the American dietetic association and 
dietitians of Canada: vegetarian diets, J Am Diet Assoc, 
103(6), 748-765 (2003) 
10. Kesqvadev J.D., Short K.R., Review Article, Diabetes in 
old age: An Emerging Epidemic, JAPI., 51, (2003) 
11. Swapna S. Kadam, Payghan B.S., Mayuri Reddy R. and 
Kumara Swamy R.C., Role of social determinant in 
Glycemic Control of Type-2 Diabetic Subjects, Int. Res. 
J. Medical Sci., 2(4), 2-6 (2014) 
12. Kaleemullah M. Khan and Mohd Nasir Mohiuddin, A 
Controlled Study on Predictors of Type 2 Diabetes in 
Nodular Diabetic Glomerulosclerosis, Int. Res. J. 
Medical Sci., 2(9), 9-15 (2014) 
13. Thakur Abhimanyu and Sushmitha Kondru, Role of Non-
HDL Cholesterol and LDLC/HDLc Ratio to Assess 
cardio vascular risk in Type- II Diabetic Patients, Int. 
Res. J. Medical Sci., 3(1), 23-28 (2015) 
14. Baijayanti Bour, Nirmala Manna and Jhuma Sarkar, 
Global Journal of Medicine and Public Health, An 
epidemiological study on risk factors of diabetes mellitus 
attending a tertiary care hospital of West Bengal, India, 
GJMEDPH, 2(4), (2013) 
15. Shishir Nigam, Shyamal Koley and Sandhu J.S., A study 
on Body Composition components in vegetarian and non 
vegetarian patients with diabetes mellitus, J.Hum. Ecol., 
22(1), 53-56 (2007) 
16. Kaur Bhagyapreet, Verma R.K. and Mishra Ravi, Recent 
Trend of Diagnosis Criteria,  Goal and Dietary 
Recommendation for Type II Diabetes and an 
Assessment of the Role  of Recommended Dietary intake 
for Good Control(DMII), Int. Res. J. Medical Sci., 2(6), 
14-18 (2014) 
17. Sutapa Agrawal and Christopher j Millett, Type of 
vegetarian diet, obesity and diabetes in adult Indian 
population, Nutrtion Journal, 13, 89 (2014) 
18. Iqbal MJ, Azhar M, Javed MT and Tahira I, Study on 
ST-Segment Elevation Acute Myocardial Infarction 
(STEMI) in diabetic and non diabetic patients, Pak J Med 
Sci, 24(6), 786-91 (2008)  
19. Linda W.H. Kao and Ian B Puddey, Alcohol 
consumption and the risk of type 2 diabetes mellitus: 
Atherosclerosis risk in community study, Ammerican 
Journal of epidemiology, 154(8), 748-57 (2001) 


Glycoslated Haemoglobin as a Diagnostic Marker of Diabetes Mellitus in Acute Myocardial Infarction and Correlation with Dietary Pattern

http://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=21CA5306D422230FBFDEBF70E7804814?doi=10.1.1.1052.2822&rep=rep1&type=pdf

Glycoslated Haemoglobin as a Diagnostic Marker of Diabetes Mellitus in Acute Myocardial Infarction and Correlation with Dietary Pattern

Abstract

Similar works

Full text

Available Versions

CiteSeerX