Association Between Hyperglycemia at Admission During Hospitalization for Acute Myocardial Infarction and Subsequent Diabetes: Insights From the Veterans Administration Cardiac Care Follow-up Clinical Study

作者：Shore Supriya; Borgerding Joleen A; Gylys Colwell Ina; McDermott Kelly; Ho P Michael; Tillquist Maggie N; Lowy Elliott; McGuire Darren K; Stolker Joshua M; Arnold Suzanne V; Kosiborod Mikhail; Maddox Thomas M^*

来源：Diabetes Care, 2014, 37(2): 409-418.

DOI：10.2337/dc13-1125

OBJECTIVEAmong patients with acute myocardial infarction (AMI) without known diabetes, hyperglycemia at admission is common and associated with worse outcomes. It may represent developing diabetes, but this association is unclear. Therefore, we examined the association between hyperglycemia (140 mg/dL) at admission and evidence of diabetes among patients with AMI without known diabetes within 6 months of their hospitalization.RESEARCH DESIGN AND METHODSWe studied a national cohort of consecutive patients with AMI without known diabetes presenting at 127 Veterans Affairs hospitals between October 2005 and March 2011. Evidence of diabetes either at discharge or in the following 6 months was ascertained using diagnostic codes, medication prescriptions, and/or elevated hemoglobin A(1c). Association between hyperglycemia at admission and evidence of diabetes was evaluated using regression modeling.RESULTSAmong 10,499 patients with AMI without known diabetes, 98% were men and 1,761 (16.8%) had hyperglycemia at admission. Within 6 months following their index hospitalization, 208 patients (11.8%) with hyperglycemia at admission had evidence of diabetes compared with 443 patients (5.1%) without hyperglycemia at admission (P < 0.001). After multivariable adjustment, hyperglycemia at admission was significantly associated with subsequent diabetes odds ratio 2.56 (95% CI 2.15-3.06). Among those with new evidence of diabetes, 41% patients (267 of 651) had a hemoglobin A(1c) 6.5% without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes.CONCLUSIONSHyperglycemia at admission occurred in one of six patients with AMI without known diabetes and was significantly associated with new evidence of diabetes in the 6 months following hospitalization. In addition, two of five patients with evidence of diabetes were potentially unrecognized. Accordingly, diabetes-screening programs for hyperglycemic patients with AMI may be an important component of optimal care.

• 出版日期2014-2