Key result
In stable patients with chronic heart failure, a 2-hour oral glucose tolerance test revealed that 80% had impaired glucose tolerance, which was related to fat distribution and left ventricular end-diastolic pressure.
Why the study?
Does a 2-hour oral glucose tolerance test identify more unrecognized diabetes compared to fasting glucose and HbA1c in stable patients with chronic heart failure?
Observational (n=56)
No
Does a 2-hour oral glucose tolerance test identify more unrecognized diabetes compared to fasting glucose and HbA1c in stable patients with chronic heart failure?
A 2-hour oral glucose tolerance test is necessary to identify the high prevalence of unrecognized diabetes and prediabetes in stable heart failure patients, as fasting glucose and HbA1c are insufficient.
Answers are grounded in this paper and cite their sources.
OGTT may uncover unrecognized glucose intolerance in most stable HF patients; leaves open whether fat distribution or LVEDP drive outcomes or warrant targeted screening.
BACKGROUND: Many patients with chronic heart failure (CHF) are believed to have unrecognized diabetes, which is associated with a worse prognosis. This study aimed to describe glucose tolerance in a general stable CHF population and to identify determinants of glucose tolerance focusing on body composition and skeletal muscle strength. METHODS: A prospective observational study was set up. Inclusion criteria were diagnosis of CHF, stable condition and absence of glucose-lowering medication. Patients underwent a 2 h oral glucose tolerance test (OGTT), isometric strength testing of the upper leg and dual energy x-ray absorptiometry. Health-related quality of life and physical activity level were assessed by questionnaire. RESULTS: Data of 56 participants were analyzed. Despite near-normal fasting glucose values, 55% was classified as prediabetic, 14% as diabetic, and 20% as normal glucose tolerant. Of all newly diagnosed diabetic patients, 79% were diagnosed because of 2 h glucose values only and none because of HbA1c. Univariate mixed model analysis revealed ischaemic aetiology, daily physical activity, E/E', fat trunk/fat limbs and extension strength as possible explanatory variables for the glucose curve during the glucose tolerance test. When combined in one model, only fat trunk/fat limbs and E/E' remained significant predictors. Furthermore, fasting insulin was correlated with fat mass/height2 (r = 0.51, p < 0.0001), extension strength (r = -0.33, p < 0.01) and triglycerides (r = 0.39, p < 0.01). CONCLUSIONS: Our data confirm that a large majority of CHF patients have impaired glucose tolerance. This glucose intolerance is related to fat distribution and left ventricular end-diastolic pressure.
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Stevens et al. (2014) conducted an observational in Chronic heart failure (n=56). Oral glucose tolerance test (OGTT) vs. Fasting glucose and HbA1c screening was evaluated on Prevalence of impaired glucose tolerance (prediabetes and diabetes). In stable patients with chronic heart failure, a 2-hour oral glucose tolerance test revealed that 80% had impaired glucose tolerance, which was related to fat distribution and left ventricular end-diastolic pressure.
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