Abstract 4: Recognition of Newly-Diagnosed Diabetes Mellitus During an Acute Myocardial Infarction
Background: Diabetes mellitus (DM) is a common comorbidity in patients hospitalized with an acute myocardial infarction (AMI), and, in some cases, the AMI hospitalization represents the first opportunity to recognize and treat DM. We sought to understand both the prevalence of incident DM and its rate of recognition among AMI patients without DM diagnosis on admission.
Methods: Patients in a 24-site U.S. AMI registry had A1C assessed at a core lab, which was blinded to clinicians. Patients could also have A1C drawn for clinical purposes. We defined DM based on A1C≥6.5% or, if A1C level was missing, based on ≥2 fasting glucose levels ≥126 mg/dL or ≥1 fasting glucose ≥126 mg/dL AND glucose at presentation ≥200 mg/dL. DM was considered recognized if the patient received DM education during the hospitalization or a DM medication at discharge. Multivariable, hierarchical logistic regression examined factors associated with recognition. Treatment with DM medications was evaluated at 6-months after discharge.
Results: Among 2854 AMI patients without known DM on admission, 287 patients (10.1%) had core lab-diagnosed DM. Among these, 198 (69%) were not recognized by the treating physicians. Median A1C of unrecognized patients was 6.7%, range of 6.5-12.3%. If the treating physician checked an A1C during the AMI, this was associated with a 17-fold increased odds of recognition (95% CI 6.0-50.2). Furthermore, if the A1C was checked and was ≥7% (vs. <7%), this was also associated with 17-fold increased odds of DM recognition (95% CI 6.3-47.1). Six months after discharge, only 6.8% of those not recognized as having DM during hospitalization had been initiated on DM medications vs. 71% of those recognized during the AMI (p<0.001).
Discussion: Among AMI patients without known DM, 1 in 10 have underlying DM. Recognition of this remains sub-optimal, with fewer than 1 in 3 patients receiving DM education or medications at discharge. The majority of unrecognized patients are not initiated on therapy during follow-up, emphasizing the importance of recognition during the AMI hospitalization. Furthermore, the strongest predictor of recognition was A1C assessment during hospitalization, highlighting an important opportunity to improve the recognition of DM and, possibly, long-term glycemic control in patients hospitalized with AMI.
Author Disclosures: S.V. Arnold: B. Research Grant; Modest; Genentech, Gilead Sciences, Sanofi Aventis. J.M. Stolker: None. K.J. Lipska: None. Y. Li: None. J.A. Spertus: B. Research Grant; Significant; NHLBI, AHA, ACCF, Gilead Sciences, Eli Lilly, EvaHeart, Amorcyte. G. Consultant/Advisory Board; Modest; United Healthcare, Genentech, Amgen. D.K. McGuire: G. Consultant/Advisory Board; Modest; F Hoffmann LaRoche, Pfizer, Daiichi Sankyo, NovoNordisk, Sanofi Aventis, Regeneron, Tethys Bioscience. G. Consultant/Advisory Board; Significant; Genentech. H. Other; Modest; Boehringer Ingelheim, Takeda, Orexigen, AstraZeneca, Bristol Myers Squibb, Eli Lilly, Daiichi Sankyo, Merck Schering Plough. S.E. Inzucchi: None. A. Goyal: None. T.M. Maddox: None. M. Lind: None. S. Shore: None. M. Kosiborod: B. Research Grant; Significant; AHA, Genentech, Sanofi Aventis, Gilead Sciences, Medtronic Minimed. G. Consultant/Advisory Board; Modest; Genentech, Gilead Sciences, F Hoffmann LaRoche, Medtronic Minimed, AstraZeneca.
- © 2014 by American Heart Association, Inc.