Abstract 13086: The Impact of Glycemic Variability on Mortality in Patients With Diabetes Hospitalized With Acute Heart Failure

Abstract

Hypothesis: Acute heart failure (AHF) in patients with diabetes is associated with increased mortality, however the impact of glycemic variability is unclear. Methods: We screened our database within 1 year to identify patients with AHF and diabetes. The glucose variables of interest were: hypoglycemia (glucose blood level <70 mg/dl); glycated haemoglobin (HbA1c); admission glycemia; mean glycemia index (MGI), defined as mean of all fasting glucose blood levels measured during hospitalization; and glycemic lability index (GLI), calculated by a validated formula, using successive glucose measurements and times between measurements. All these parameters were added to conventional potential prognostic markers: left ventricular ejection fraction (LVEF), admission systolic/diastolic blood pressure (SBP/DBP) and mean of all measurements during hospitalization (SBPm/DBPm), presence of respiratory failure, mechanical ventilation, atrial arrhythmias, troponin I and NTproBNP values, admission renal function (GRF) and mean of all measurements during hospitalization (GRFm). The outcome was in-hospital mortality. Results: 113 patients (70±10yrs, 56% men) were identified. 13 patients (12%) died. Admission glycemia (341±81 vs 228±105 mg/dl), MGI (287±108 vs 164±38 mg/dl), GLI (18161±24774 vs 6408±18108 mg/dl 2 /h) were higher in non-survivors, whereas LVEF (22±12 vs 34±12%), SBP (102±43 vs 154±43 mmHg), SBPm (92±37vs127±25 mmHg), DBPm (76±11vs.56±24), and GRFm (37±22 vs 57±27 ml/min) were lower (all p<0.01). Presence of atrial arrhythmias, respiratory failure, but not mechanical ventilation was higher in non-survivors; hypoglicemia, HbA1c, troponin I, NTproBNP, and GRF were similar. Only MGI≥188 mg/dl and LVEF≤28% were independently associated with in-hospital mortality (Figure). Conclusions: Parameters of glycemic variability and LVEF are associated with in-hospital mortality in patients with diabetes hospitalized with AHF.