Patients with prediabetes in the outpatient cardiology practice: challenges in the diagnosis and management of initial carbohydrate metabolism disorders

Aim. To investigate the characteristics of diagnosis and pharmacotherapy of initial carbohydrate metabolism disorders (prediabetes) in cardiology patients within the framework of an outpatient registry
Material and methods. An observational cross-sectional study was conducted as part of the outpatient registry on inappropriate prescribing practices known as CHIP (Chuvashia Inappropriate Prescribing Study). The study focused on patients over 50 years old who sought consultation from a cardiologist at the cardiology dispensary. Data from the cardiologist’s outpatient records and patients’ medical documentation were analyzed based on the registry database. The term “impaired glucose tolerance (IGT)” in the registry records was used as an equivalent to “prediabetes”. Adherence to pharmacotherapy was assessed using the adherence scale developed by the National Society of Evidence-Based Pharmacotherapy.
Results. The CHIP registry included 300 patients: 120 (40%) men and 180 (60%) women. The mean age of the participants was 66.4±7.6 years. Baseline data on the absence/presence of carbohydrate metabolism disorders in the 300 registry patients were as follows: 202 patients had no carbohydrate metabolism disorders; 30 patients were diagnosed with impaired glucose tolerance (IGT): 67 had type 2 diabetes mellitus (T2DM), and 1 had type 1 diabetes (this patient’s data were excluded from further analysis). The most common test for assessing carbohydrate metabolism was the fasting blood glucose measurement, performed in 98% of the patients; HbA1c levels were determined in 22.4% of the participants, and only 12 patients (4%) underwent an oral glucose tolerance test (OGTT). Analysis of these test results indicated that 17 patients initially classified in the “no carbohydrate disorders” subgroup had fasting blood glucose levels meeting the criteria for prediabetes, while an additional 12 individuals from this subgroup and 13 patients with an original diagnosis of IGT met the criteria for T2DM. According to final data, 173 (57.9%) individuals in the studied cohort had no carbohydrate metabolism disorders, 34 (11.4%) had prediabetes, and 92 (30.7%) had T2DM. Waist circumference and body mass index (BMI) significantly increased in the T2DM group. An increase in the frequency of comorbidities, including arterial hypertension, chronic heart failure, atrial fibrillation, and ischemic heart disease (p=0.003), as well as a history of myocardial infarction, has been observed in patients with prediabetes and diabetes mellitus compared to those without carbohydrate metabolism disorders. The highest number of patients non-adherent to pharmacotherapy was observed in the subgroup without carbohydrate disorders, while the lowest was found among patients with T2DM. Metformin was prescribed to one in five patients diagnosed with prediabetes.
Conclusion. This study highlights the incomplete diagnosis of carbohydrate metabolism disorders, specifically prediabetes and type 2 diabetes mellitus, among cardiology patients. Furthermore, it illustrates the infrequent prescription of metformin for diabetes prevention, underscoring the critical need for heightened diagnostic vigilance regarding early carbohydrate disturbances in outpatient settings, not only by endocrinologists but also by physicians from other specialties.

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