Temporal change in glucose tolerance in non-ST-elevation myocardial infarction

We assessed the prevalence and 3-month change in glucose tolerance status in consecutive non-ST-elevation myocardial infarction (NSTEMI; European Society of Cardiology 2007 definition) patients (N=49; mean (S.D.) age 65 (11) years) admitted to a coronary care unit, without known diabetes. These patients underwent an oral glucose tolerance test (OGTT) 36-hour (median, IQR: 18-72) after admission and at 3 months. Undiagnosed abnormal glucose tolerance (AGT: impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or new diabetes) was common (61% at admission and 41% at 3 months, p<0.05) and the majority (approximately 3/4) had IGT. Glucose tolerance status improved in a higher proportion of patients than it worsened (31% vs. 8%, p=0.04). At 3 months, fasting glucose was unchanged but 2-hour OGTT glucose was lower (mean (S.D.): 8.5 (2.7) mmol/L vs. 7.7 (2.7) mmol/L, p=0.004). 'Stress hyperglycaemia' could explain higher admission glucose levels and this raises the question about the optimal timing of OGTT in relation to myocardial infarction. Newly diagnosed diabetes was present in approximately 10% of patients and this was not reliably detected by fasting plasma glucose. In NSTEMI patients OGTT is the only reliable strategy to identify subjects with IGT and diabetes.

Frailty and muscle function: role for testosterone?

Frailty is a clinical syndrome characterised by reduced physiologic reserve affecting multiple organ systems and is associated with increased risk of falls, fractures, hospitalisation and death. The impact of agerelated physical frailty on well-being and health in older men and the potential for prevention and treatment are beginning to be explored. Frailty is multifactorial with aging, comorbidity, sarcopenia, and endocrine immune dysfunction contributing to the condition. Falling testosterone levels with advancing age are associated with muscle loss (sarcopenia) and strength. Among the various therapeutic options being considered, testosterone supplementation offers promise due to its anabolic effects on muscle. In this review, we discuss the syndrome of frailty, its relationship with low testosterone and the effects of testosterone supplementation in healthy and unhealthy/frail older men on muscle mass, strength and physical performance.