Diabetes mellitus is a well recognised risk factor for cardiovascular disease and diabetic individuals with acute coronary syndrome (ACS) have a two- to fourfold increased risk of adverse cardiovascular events compared to non-diabetic individuals.¹ It is becoming increasingly clear that impaired glucose metabolism and the pre-diabetic state are also associated with adverse clinical outcomes. A retrospective study of 197 patients by Norhammar et al² showed that among non-diabetic patients with acute myocardial infarction, those with higher admission blood glucose had higher rates of death, rehospitalisation for heart failure, and rehospitalisation for non-fatal reinfarction. In this study, admission plasma glucose was an independent predictor of non-fatal reinfarction, hospitalisation for heart failure, and a major adverse cardiovascular event (MACE).² Another study by Norhammar et al revealed that 35% of patients admitted to the coronary care unit with a myocardial infarction and no prior diagnosis of diabetes may have an abnormal glucose tolerance test at discharge.³

The American Diabetes Association (ADA) recently redefined the cut off point for normal fasting blood glucose concentrations from 110 mg/dl to 100 mg/dl, meaning that a value of 100 mg/dl or above would lead to a diagnosis of impaired fasting glucose, which is included in the term pre-diabetes.⁴ The impact of the new guideline is immense. Health and human services estimate that …