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

Supriya Shore, Joleen A. Borgerding, Ina Gylys-Colwell, Kelly McDermott, P. Michael Ho, Maggie N. Tillquist, Elliott Lowy, Darren K McGuire, Joshua M. Stolker, Suzanne V. Arnold, Mikhail Kosiborod, Thomas M. Maddox

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Abstract

OBJECTIVE Among 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 METHODS We 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 A1c. Association between hyperglycemia at admission and evidence of diabetes was evaluated using regression modeling. RESULTS Among 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 comparedwith 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 A1c ≥6.5% without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes. CONCLUSIONS Hyperglycemia 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, diabetesscreening programs for hyperglycemic patients with AMI may be an important component of optimal care.

Original languageEnglish (US)
Pages (from-to)409-418
Number of pages10
JournalDiabetes Care
Volume37
Issue number2
DOIs
StatePublished - Feb 2014

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United States Department of Veterans Affairs
Hyperglycemia
Hospitalization
Myocardial Infarction
Prescriptions
Hemoglobins
Clinical Studies
Veterans Hospitals
Odds Ratio

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing
  • Medicine(all)

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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. / 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.

In: Diabetes Care, Vol. 37, No. 2, 02.2014, p. 409-418.

Research output: Contribution to journalArticle

Shore, S, Borgerding, JA, Gylys-Colwell, I, McDermott, K, Ho, PM, Tillquist, MN, Lowy, E, McGuire, DK, Stolker, JM, Arnold, SV, Kosiborod, M & Maddox, TM 2014, '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', Diabetes Care, vol. 37, no. 2, pp. 409-418. https://doi.org/10.2337/dc13-1125
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. / 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. In: Diabetes Care. 2014 ; Vol. 37, No. 2. pp. 409-418.
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abstract = "OBJECTIVE Among 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 METHODS We 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 A1c. Association between hyperglycemia at admission and evidence of diabetes was evaluated using regression modeling. RESULTS Among 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 comparedwith 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 A1c ≥6.5{\%} without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes. CONCLUSIONS Hyperglycemia 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, diabetesscreening programs for hyperglycemic patients with AMI may be an important component of optimal care.",
author = "Supriya Shore and Borgerding, {Joleen A.} and Ina Gylys-Colwell and Kelly McDermott and Ho, {P. Michael} and Tillquist, {Maggie N.} and Elliott Lowy and McGuire, {Darren K} and Stolker, {Joshua M.} and Arnold, {Suzanne V.} and Mikhail Kosiborod and Maddox, {Thomas M.}",
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T1 - Association between hyperglycemia at admission during hospitalization for acute myocardial infarction and subsequent diabetes

T2 - Insights from the veterans administration cardiac care follow-up clinical study

AU - Shore, Supriya

AU - Borgerding, Joleen A.

AU - Gylys-Colwell, Ina

AU - McDermott, Kelly

AU - Ho, P. Michael

AU - Tillquist, Maggie N.

AU - Lowy, Elliott

AU - McGuire, Darren K

AU - Stolker, Joshua M.

AU - Arnold, Suzanne V.

AU - Kosiborod, Mikhail

AU - Maddox, Thomas M.

PY - 2014/2

Y1 - 2014/2

N2 - OBJECTIVE Among 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 METHODS We 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 A1c. Association between hyperglycemia at admission and evidence of diabetes was evaluated using regression modeling. RESULTS Among 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 comparedwith 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 A1c ≥6.5% without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes. CONCLUSIONS Hyperglycemia 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, diabetesscreening programs for hyperglycemic patients with AMI may be an important component of optimal care.

AB - OBJECTIVE Among 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 METHODS We 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 A1c. Association between hyperglycemia at admission and evidence of diabetes was evaluated using regression modeling. RESULTS Among 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 comparedwith 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 A1c ≥6.5% without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes. CONCLUSIONS Hyperglycemia 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, diabetesscreening programs for hyperglycemic patients with AMI may be an important component of optimal care.

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