Arnold Suzanne V, Stolker Joshua M, Lipska Kasia J, Jones Philip G, Spertus John A, McGuire Darren K, Inzucchi Silvio E, Goyal Abhinav, Maddox Thomas M, Lind Marcus, Gumber Divya, Shore Supriya, Kosiborod Mikhail
From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., P.G.J., J.A.S., M.K.); University of Missouri-Kansas City (S.V.A., J.A.S., M.K.); Saint Louis University, MO (J.M.S.); Yale University School of Medicine, New Haven, CT (K.J.L., S.E.I.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Emory School of Medicine, Atlanta, GA (A.G.); VA Eastern Colorado Health Care System, Denver (T.M.M.); University of Gothenburg, Gothenburg, Sweden (M.L.); and Cleveland Clinic Foundation, OH (D.G.).
Circ Cardiovasc Qual Outcomes. 2015 May;8(3):260-7. doi: 10.1161/CIRCOUTCOMES.114.001452. Epub 2015 Apr 21.
Diabetes mellitus (DM) is common in patients hospitalized with an acute myocardial infarction (AMI), representing in some cases the first opportunity to recognize and treat DM. We report the incidence of new DM and its recognition among patients with AMI.
Patients in a 24-site US AMI registry (2005-08) had glycosylated hemoglobin assessed at a core laboratory, with results blinded to clinicians and local clinical measurements left to the discretion of the treating providers. Among 2854 AMI patients without known DM on admission, 287 patients (10%) met criteria for previously unknown DM, defined by a core laboratory glycosylated hemoglobin of ≥6.5%. Among these, 186 (65%) were unrecognized by treating clinicians, receiving neither DM education, glucose-lowering medications at discharge, nor documentation of DM in the chart (median glycosylated hemoglobin of unrecognized patients, 6.7%; range, 6.5-12.3%). Six months after discharge, only 5% of those not recognized as having DM during hospitalization had been initiated on glucose-lowering medications versus 66% of those recognized (P<0.001).
Underlying DM that has not been previously diagnosed is common among AMI patients, affecting 1 in 10 patients, yet is recognized by the care team only one third of the time. Given its frequency and therapeutic implications, including but extending beyond the initiation of glucose-lowering treatment, consideration should be given to screening all AMI patients for DM during hospitalization. Inexpensive, ubiquitous, and endorsed as an acceptable screen for DM, glycosylated hemoglobin testing should be considered for this purpose.
糖尿病（DM）在急性心肌梗死（AMI）住院患者中很常见，在某些情况下是识别和治疗糖尿病的首次机会。我们报告了急性心肌梗死患者中新发糖尿病的发病率及其识别情况。
在美国一个24个中心的急性心肌梗死登记处（2005 - 2008年）的患者中，糖化血红蛋白在一个核心实验室进行评估，结果对临床医生保密，当地临床测量由治疗提供者自行决定。在2854例入院时无已知糖尿病的急性心肌梗死患者中，287例（10%）符合先前未知糖尿病的标准，该标准由核心实验室糖化血红蛋白≥6.5%定义。其中，186例（65%）未被治疗临床医生识别，出院时既未接受糖尿病教育，也未接受降糖药物治疗，病历中也没有糖尿病记录（未被识别患者的糖化血红蛋白中位数为6.7%；范围为6.5 - 12.3%）。出院6个月后，住院期间未被识别为患有糖尿病的患者中只有5%开始使用降糖药物，而被识别的患者中这一比例为66%（P<0.001）。
先前未被诊断出的潜在糖尿病在急性心肌梗死患者中很常见，每10名患者中就有1例受影响，但护理团队仅在三分之一的情况下能识别出来。鉴于其发生率和治疗意义，包括但不限于启动降糖治疗，应考虑在住院期间对所有急性心肌梗死患者进行糖尿病筛查。糖化血红蛋白检测价格低廉、随处可得，且被认可为糖尿病的可接受筛查方法，应考虑用于此目的。
