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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3135 — Hyperglycemia During MI Hospitalization Predicts Subsequent Diabetes: Insights from the VA IHD-QUERI Cardiac Care Follow-Up Clinical Study (CCFCS)

Maddox TM, VA Eastern Colorado Healthcare System/University of Colorado, Denver; Gylys-Colwell I, and McDermott K, VA Puget Sound Healthcare System; Ho PM, VA Eastern Colorado Healthcare System/University of Colorado, Denver; Tillquist M, University of Colorado, Denver; Lowy E, VA Puget Sound Healthcare System; McGuire DK, University of Texas Southwestern; Stolker JM, St. Louis University; Kosiborod M, Mid-America Heart Institute;

Objectives:
Among non-diabetic acute myocardial infarction (AMI) patients, those with inpatient hyperglycemia have higher mortality than those without. Although this hyperglycemia may represent undiagnosed diabetes mellitus (DM) and its attendant poor outcomes, rates of new DM diagnosis among these patients after AMI hospitalization are poorly characterized.

Methods:
We studied a national cohort of non-DM AMI patients in the VA system between October 2005 and January 2009. We assessed mean glucose levels during hospitalization and rates of DM diagnosis in the 6 months following. Per prior studies, hyperglycemia was defined as mean hospitalized glucose >140mg/dL. DM diagnosis was determined by ICD-9 codes, DM drug prescription, or A1c > 6.5%. Predictors of DM diagnosis were assessed using a multivariable logistic regression model with a backwards selection algorithm.

Results:
Among 7,628 non-DM ACS patients, 567 (7.4%) had hyperglycemia during their hospitalization. Hyperglycemic patients were more likely to be older, to have higher body-mass index, smoke, have prior cardiac or pulmonary disease, and undergo inpatient CABG rather than PCI. They were less likely to be discharged on anti-platelet medications. In the 6 months following discharge, 200 (35.3%) hyperglycemic patients were diagnosed with DM, compared with 455 (6.4%) normoglycemic patients (p <0.0001). After adjustment for demographic, clinical and treatment variables, hyperglycemia during hospitalization was a significant predictor of incident DM (OR 6.5, 95% CI 5.3, 8.1). The c-statistic for the overall model was 0.8, indicating good discrimination, and R2 = 0.17.

Implications:
In-hospital hyperglycemia is a significant predictor of incident DM following ACS, with over one-third of non-DM hyperglycemic patients receiving the diagnosis in the following 6 months. Our findings suggest that non-DM AMI patients with hyperglycemia warrant formal DM screening during or shortly after AMI hospitalization.

Impacts:
Our study highlights the high prevalence of DM that occurs among AMI patients with inpatient hyperglycemia. These findings suggest that formal screening of hyperglycemic patients is likely to identify a large number of diabetic patients who can then benefit from anti-glycemic therapies and subsequent reductions in adverse outcomes.


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