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Hyperglycemia at hospitalization increased risk for future diabetes in MI patients
Approximately one in six patients hospitalized for acute MI have hyperglycemia without known diabetes, and these patients are at a 2.5-fold increased risk of showing signs of diabetes within 6 months of discharge, according to recent findings.
The researchers gathered data on 10,499 patients (98% male) from the Department of VA Cardiac Care Follow-Up Clinical Study, which monitors various medical conditions and procedures using national data from the Veterans Health Administration’s External Peer Review Program. Records of all patients discharged with a diagnosis of ACS from 127 VA hospitals from October 2005 to March 2011 were assessed. The researchers defined hyperglycemia as serum glucose value ≥140 mg/dL and recorded glucose values tested through blood samples collected upon admission.
Hyperglycemia during acute MI hospitalization was the primary independent variable of the study. The primary outcome was evidence of diabetes at discharge or within 6 months post-discharge, with evidence defined as an ICD-9 CM code for diabetes, a prescription for glucose-lowering medications and/or HbA1c ≥6.5% at the time of hospitalization or after discharge.
Of the 10,499 evaluated patients, 16.8% had hyperglycemia at the time of admission. New evidence of diabetes was observed in 6.2% of the cohort between index hospitalization and 6 months post-discharge, including 11.8% of those with hyperglycemia and 5.1% of those without hyperglycemia upon admission (P<.001).
Multivariable adjustment indicated a significant association between hyperglycemia at admission and risk for diabetes (OR=2.56; 95% CI, 2.15-3.06). Moreover, among those who showed later evidence of diabetes, 41% had HbA1c ≥6.5%, with no corresponding diagnostic codes or diabetes medication prescriptions, indicating that their diabetes had not been diagnosed. Factors associated with exhibiting evidence of diabetes included non-white race (OR=1.55; 95% CI, 1.3-1.86), hypertension (OR=1.29; 95% CI, 1.04-1.59), obesity (OR=1.81; 95% CI, 1.51-2.16), presenting with a non-STEMI (OR=1.27; 95% CI, 1.02-1.57), elevated triglycerides (OR=1.49; 95% CI, 1.24-1.8 for >150 mg/dL) and lower levels of HDL (OR=1.33; 95% CI, 1.09-1.63 for <40 mg/dL).
According to the researchers, these findings suggest the potential utility of screening acute MI patients for diabetes, particularly those who present with hyperglycemia.
“Systematic screening for diabetes among hyperglycemic patients with [acute] MI may provide opportunities for prompt identification, improved risk stratification, institution of optimal diabetes and [acute] MI treatments and improved outcomes,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.