A precise oral glucose loading 18F-FDG PET myocardial metabolic imaging protocol in coronary artery disease patients complicated by diabetes mellitus: an exploratory prospective cohort study

By
Liang Yin
Yangyang Lin
Jianlan Yue
Zhichun Lin
Hongtao Sun
July 10, 2026
0 min

Frontiers In Medicine

Overview

This study evaluates the feasibility of a tailored oral glucose loading protocol combined with insulin administration for 18F-FDG PET myocardial metabolic imaging in diabetic patients with coronary artery disease.

Background

Coronary artery disease (CAD) is a leading cause of morbidity and mortality globally, particularly among patients with diabetes mellitus (DM). Accurate assessment of myocardial viability is crucial for determining appropriate treatment strategies, especially prior to surgical interventions. Traditional imaging protocols may not adequately address the unique metabolic needs of diabetic patients, necessitating further exploration of optimized approaches.

Data Highlights

Blood Glucose Level	Image Quality (Excellent)	Image Quality (Very Good)	Image Quality (Good)	Image Quality (Fair)	Image Quality (Non-Diagnostic)
>7.77 mmol/L	43.1%	43.1%	9.8%	3.9%	0%
5.55–7.77 mmol/L	60.4%	30.7%	5.9%	1.0%	2.0%
<5.55 mmol/L	74.1%	14.8%	11.1%	0%	0%

Key Findings

179 CAD patients with DM were enrolled in the study.
Image quality was rated as excellent in 57.5% of cases, with a small percentage being non-diagnostic (1.1%).
Patients with blood glucose levels >7.77 mmol/L had significantly lower odds of achieving excellent image quality (p = 0.021).
26.3% of patients exhibited completely viable myocardium, while 49.7% had partially viable myocardium.
No severe adverse reactions were reported during the imaging process.

Clinical Implications

The tailored oral glucose loading protocol may improve the quality of myocardial imaging in diabetic patients with CAD.

Conclusion

The study demonstrates that a precise oral glucose loading protocol prior to 18F-FDG injection is feasible and can enhance image quality in clinical settings.