One in 10 AMI Patients Have Unrecognized Incident Diabetes Few not recognized as having DM during hospitalization on six months after discharge. Marcus Lind, Sweden et al. Cardiovascular quality and outcomes. April 21 2015

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altTHURSDAY, April 23, 2015 (HealthDay News) -- One in 10 acute myocardial infarction (AMI) patients without a previous diagnosis of diabetes mellitus (DM) have underlying DM, according to research published online April 21 in Circulation: Cardiovascular Quality and Outcomes.

Suzanne V. Arnold, M.D., M.H.A., from Saint Luke's Mid America Heart Institute in Kansas City, Mo., and colleagues reported on the incidence of new DM and its recognition among patients with AMI. Data were included for patients in a 24-site U.S. AMI registry from 2005 to 2008.

The researchers found that 10 percent of the 2,854 AMI patients without known DM on admission met criteria for previously unknown DM, defined by a core laboratory glycosylated hemoglobin of ≥6.5 percent. Sixty-five percent of these cases were unrecognized by treating clinicians, and had not received DM education, glucose-lowering medications at discharge, or documentation of DM in the chart.

At six months after discharge, initiation on glucose-lowering medications occurred in 5 percent of those not recognized as having DM during hospitalization, compared to 66 percent of those recognized as having DM (P < 0.001).

"Underlying DM that has not been previously diagnosed is common among AMI patients, affecting one in 10 patients, yet is recognized by the care team only one-third of the time," the authors write. "Given its frequency and therapeutic implications, including but extending beyond the initiation of glucose-lowering treatment, consideration should be given to screening all AMI patients for DM during hospitalization."

From http://www.physiciansbriefing.com

 

Abstract

Recognition of Incident Diabetes Mellitus During an Acute Myocardial Infarction

  1. Suzanne V. Arnold, MD, MHA,
  2. Joshua M. Stolker, MD,
  3. Kasia J. Lipska, MD, MHS,
  4. Philip G. Jones, MS,
  5. John A. Spertus, MD, MPH,
  6. Darren K. McGuire, MD, MHSc,
  7. Silvio E. Inzucchi, MD,
  8. Abhinav Goyal, MD, MHS,
  9. Thomas M. Maddox, MD, MSc,
  10. Marcus Lind, MD,
  11. Divya Gumber, MD,
  12. Supriya Shore, MD and
  13. Mikhail Kosiborod, MD

+ Author Affiliations

  1. From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., P.G.J., J.A.S., M.K.); University of Missouri-Kansas City (S.V.A., J.A.S., M.K.); Saint Louis University, MO (J.M.S.); Yale University School of Medicine, New Haven, CT (K.J.L., S.E.I.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Emory School of Medicine, Atlanta, GA (A.G.); VA Eastern Colorado Health Care System, Denver (T.M.M.); University of Gothenburg, Gothenburg, Sweden (M.L.); and Cleveland Clinic Foundation, OH (D.G.).
  1. Correspondence to Suzanne V. Arnold, MD MHA, Saint Luke’s Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail Den här e-postadressen skyddas mot spambots. Du måste tillåta JavaScript för att se den.

Abstract

Background—Diabetes mellitus (DM) is common in patients hospitalized with an acute myocardial infarction (AMI), representing in some cases the first opportunity to recognize and treat DM. We report the incidence of new DM and its recognition among patients with AMI.

Methods and Results—Patients in a 24-site US AMI registry (2005–08) had glycosylated hemoglobin assessed at a core laboratory, with results blinded to clinicians and local clinical measurements left to the discretion of the treating providers. Among 2854 AMI patients without known DM on admission, 287 patients (10%) met criteria for previously unknown DM, defined by a core laboratory glycosylated hemoglobin of ≥6.5%. Among these, 186 (65%) were unrecognized by treating clinicians, receiving neither DM education, glucose-lowering medications at discharge, nor documentation of DM in the chart (median glycosylated hemoglobin of unrecognized patients, 6.7%; range, 6.5–12.3%). Six months after discharge, only 5% of those not recognized as having DM during hospitalization had been initiated on glucose-lowering medications versus 66% of those recognized (P<0.001).

Conclusions—Underlying DM that has not been previously diagnosed is common among AMI patients, affecting 1 in 10 patients, yet is recognized by the care team only one third of the time. Given its frequency and therapeutic implications, including but extending beyond the initiation of glucose-lowering treatment, consideration should be given to screening all AMI patients for DM during hospitalization. Inexpensive, ubiquitous, and endorsed as an acceptable screen for DM, glycosylated hemoglobin testing should be considered for this purpose.

Accepted March 31, 2015.

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