Ten percent of patients who presented with acute MI to 24 U.S. hospitals during a 3-year study had unrecognized diabetes, and only one-third of these cases were identified during the MI hospitalization, according to a report published online April 21 in Circulation: Cardiovascular Quality and Outcomes.
To determine the prevalence of underlying but undiagnosed diabetes among patients hospitalized with acute MI, investigators reviewed the records of 2,854 patients enrolled in an MI registry. They identified 287 patients (10.1%) whose records showed HbA1c levels of 6.5% or higher on routine laboratory testing and/or elevated fasting glucose levels at admission or during the typically 48- to 72-hour hospitalization.
Dr. Suzanne V. Arnold
Treating physicians recognized only 101 of these cases of diabetes (35%), as evidenced by their provision of diabetes education, prescription of glucose-lowering medication at discharge, or diagnosis code documentation in the patients’ charts, said Dr. Suzanne V. Arnold of Saint Luke’s Mid America Heart Institute, Kansas City, Mo., and her associates.
The routine use of HbA1c testing varied dramatically from one medical center to another, with some hospitals screening fewer than 10% of acute MI patients and others screening up to 82%. Incorporating universal HbA1c screening into standardized acute MI care would likely improve these rates, the investigators said (Circ. Cardiovasc. Qual. Outcomes 2015 April 21 [doi:10.1161/circoutcomes.114.001452]).
Fully 20% of the patients with unrecognized diabetes had very high HbA1c values, ranging as high as 12.3%. Few of them received glucose-lowering medications during the 6 months after hospital discharge. “These data highlight a continued need to screen acute MI patients with HbA1c, to improve the rate of diabetes recognition during the hospitalization; this would not only guide initiation of glucose management interventions but also inform several key aspects of post-MI cardiovascular care,” such as the timing and type of revascularization procedures and the selection of ACE inhibitors, beta-blockers, aldosterone inhibitors, and antiplatelet agents, they added.