Response to Comment on Paolisso et al. Impact of Admission Hyperglycemia on Heart Failure Events and Mortality in Patients With Takotsubo Syndrome at Long-term Follow-up: Data From HIGH-GLUCOTAKO Investigators. Diabetes Care 2021;44:2158–2161

In a letter in this issue of Diabetes Care , Madias suggests that norepinephrine, as mediator of admission hyperglycemia (AH), is an index of increased underlying sympathetic overactivity and/or diabetes comorbidity in patients with takotsubo syndrome (TTS) (1). Indeed, the 28 patients with AH versus the 48 patients without AH had a higher prevalence of diabetes (39.3% vs. 14.6%) (1,2). Notably, AH was a predictor of long-term prognosis in TTS patients (2). Moreover, the patients with AH showed lower left ventricular ejection fraction on admission and discharge and higher B-type natriuretic peptide and inflammatory markers, with the glucose values correlating with serum norepinephrine levels …