Type 2 Diabetes and Myocardial Infarction in Central India: A Study and Review

Abstract

Background: Clinical experience in specific geo-demographic contexts in diabetes and myocardial infarction (MI) deserves examination in the context of current medical knowledge and redefinition for enlightened evidence based medical practice. Aim: Study aims to examine regional significance of known risk factors in incidence and outcome of MI in diabetics in comparison with non-diabetics. Methods: Cases of myocardial infarction managed over 18 month period at medical college setting in central India in 35 to 75 year age range and free from major systemic co-morbidities were comparatively studied by categorizing as diabetic and non-diabetics. Demographic, clinical and laboratory information as well as complications and outcome profiles were assessed. Results: MI in diabetics occurred at younger age, was common among women, overweight subjects and those with positive family history of ischaemic heart disease. Smokers and hypertensive’s had high prevalence in MI cases among non-diabetics group. Poor glycaemic control and dyslipidaemia were common features in diabetic MI that was largely anterior suggesting extensive coronary atherosclerosis. Although statistically insignificant, most post infarct complications were more frequent among diabetics. Hospital stay was significantly longer for diabetic MI cases.                                                                                           Conclusion: Study observations emphasize preventive role for dietary and lifestyle modification, weight reduction in diabetics and deterrence of smoking in non-diabetics as crucial. Management of hypertension is a necessary measure while good glycaemic control and correction of dyslipidaemia is pertinent in diabetics to reduce incidence and possibly severity of MI relevant in central Indian context. Angiotensin Converting Enzyme (ACE) inhibitors, beta adrenergic blockers and statins besides emergent glycaemic control with insulin have particular therapeutic relevance in diabetic MI.