Corresponding author: Thomas M. Maddox,
Diabetes Care. 2014 Feb;37(2):409-18. doi: 10.2337/dc13-1125. Epub 2013 Oct 2.
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.
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.
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 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 A1c ≥6.5% without accompanying diagnostic codes or medication prescriptions, suggesting they had unrecognized diabetes.
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, diabetes-screening programs for hyperglycemic patients with AMI may be an important component of optimal care.
在无已知糖尿病的急性心肌梗死（AMI）患者中，入院时的高血糖很常见，且与较差的预后相关。它可能代表新发糖尿病，但这种关联尚不清楚。因此，我们在无已知糖尿病的 AMI 患者中，在其住院后 6 个月内，检查了入院时的高血糖（≥140mg/dL）与糖尿病证据之间的关联。
我们研究了一个全国性队列，包括 2005 年 10 月至 2011 年 3 月期间在 127 家退伍军人事务医院就诊的无已知糖尿病的连续 AMI 患者。使用诊断代码、药物处方和/或升高的糖化血红蛋白（HbA1c）在出院时或之后的 6 个月内确定糖尿病证据。使用回归模型评估入院时的高血糖与糖尿病证据之间的关联。
在 10499 例无已知糖尿病的 AMI 患者中，98%为男性，1761 例（16.8%）入院时存在高血糖。在其指数住院后 6 个月内，与入院时无高血糖的 443 例患者相比（5.1%），入院时存在高血糖的 208 例患者有糖尿病证据（P<0.001）。在多变量调整后，入院时的高血糖与随后的糖尿病比值比显著相关（2.56[95%CI 2.15-3.06]）。在有新糖尿病证据的患者中，41%（267/651）的患者 HbA1c≥6.5%，无相应的诊断代码或药物处方，提示存在未被识别的糖尿病。
在无已知糖尿病的 AMI 患者中，有六分之一的患者入院时存在高血糖，与住院后 6 个月内新发糖尿病证据显著相关。此外，有五分之一的糖尿病证据患者可能是未被识别的。因此，对高血糖 AMI 患者进行糖尿病筛查可能是最佳治疗的重要组成部分。
