Abstract 387: Utility of Glycated Hemoglobin for Assessment of Glucose Metabolism in Patients with ST segment elevation Myocardial Infarction

Abstract

Background: The performance of glucose tolerance test (OGTT) in patients with STEMI results in the new recognition of diabetes mellitus (DM) in over 25% of subjects. However, due to presence of stress hyperglycemia and critical patient condition, diagnosis of DM using traditional tests (fasting glucose and OGTT) during initial hospital stay is challenging. The ADA definition now enables use of HbA1c for diagnosis of DM. We sought to evaluate the incidence and trends in newly diagnosed DM utilizing HbA1c in patients with STEMI. Methods: Consecutive patients (N=1,812) undergoing primary PCI for STEMI at the Cleveland Clinic between Jan 05-Dec 12 were included. Medical charts were queried to identify patients with an established history of DM. Admission HbA1c was used to identify patients with previously undiagnosed DM (HbA1c ≥ 6.5) and pre DM (HbA1c ≥ 5.7 and < 6.5). Results: Mean age was 60 years with 68% males. Overall, 428 patients (23.6%) had an established history of DM. Of the remainder, only 118 (8.5%) were diagnosed with DM while 593 patients (42.9%) had pre-DM based on admission HbA1c (Figure 1). There was no significant increase in mean body mass index (BMI) and incidence of DM over time (p=0.5). Conclusions: Utilization of admission HBA1c in patients with STEMI enables cardiologists to establish a new diagnosis of DM in a significant minority of subjects. Although convenient, HbA1c appears to under diagnose DM when compared to historical data with OGTT. Despite the increasing prevalence of obesity and DM in overall US population, we did not observe differences in mean BMI and prevalence of DM over time. The manifest cardiovascular consequences of DM may yet represent the exposed tip of the iceberg.