Precise Diabetes Diagnosis Determines Therapeutic Strategies In Patients With Cardiovascular Events

This article presents the case of an obese patient after his first myocardial infarction. While HbA(1c) levels were borderline, the results of the oral glucose tolerance test (oGTT) unmasked overt diabetes. Clinical parameters (HOMA2-IR score assessed from fasting glucose and insulin levels) and the clinical-experimental hyperinsulinemic-euglycemic clamp test showed whole body and tissue-specific insulin resistance. Liver steatosis was verified in magnetic resonance spectroscopy. Using the established cluster variables GAD-antibodies, age, body mass index, HbA(1c), HOMA2-B and HOMA2-IR, the patient was diagnosed with SIRD (severe insulin-resistant diabetes). SIRD corresponds to a severe course of the disease with a prognostic high probability of the occurrence of concomitant and subsequent diseases. Overweight patients diagnosed with their first myocardial infarction should be subjected of oGTT to rule out diabetes and be examined for liver and kidney function. Early diagnosis and risk stratification of individuals with diabetes allows individualized treatment regimens and patients with an increased risk profile can be monitored more closely, so that complications may be prevented and lead to an optimized primary care regime.