Long-term Glycemic Control In Patients Research Articles

Differences In HbA1c Levels In Diabetes Mellitus Patients Using Capillary And Venous blood Samples

Introduction: HbA1c is a non-enzymatic binding of glucose molecules to hemoglobin through a post- translational glycation process, measuring the level or percentage of glucose bound to hemoglobin, this parameter is used as the main benchmark for controlling Diabetes Mellitus because HbA1c can describe blood sugar levels within a period of 1- 3 months due to red blood cells bound by glucose molecules. HbA1c examination is an examination of glycemic levels which is useful to determine long-term glycemic control in patients with Diabetes Mellitus. From this study to determine differences in HbA1c levels in diabetes mellitus patients using capillary and venous blood samples. Method: Cross-sectional, this research was conducted at the Hematology Laboratory of the Palembang Muhammadiyah Institute of Health and Technology. The population taken was Diabetes Mellitus Patients in the Muhammadiyah Palembang Hospital laboratory. The sample used in this study was 29 samples using purposive sampling. Results: The average HbA1c level was found in 7.91% capillary blood and 7.91% venous blood. Discussion: The conclusion in this study is that capillary and venous blood sampling can be used to check HbA1c levels.

Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis.

Obstructive sleep apnoea is a highly prevalent chronic disorder and has been shown to be associated with disturbed glucose metabolism and type 2 diabetes. However, the evidence from individual clinical trials on the effect of continuous positive airway pressure (CPAP) treatment on glycaemic control in patients with co-existing obstructive sleep apnoea and type 2 diabetes remains controversial. A systematic review of randomised controlled trials assessing the effect of CPAP on glycaemic control in patients with obstructive sleep apnoea and type 2 diabetes was conducted using the databases MEDLINE, Embase, Cochrane and Scopus up to December 2022. Meta-analysis using a random-effect model was performed for outcomes that were reported in at least two randomised controlled trials. From 3031 records screened, 11 RCTs with a total of 964 patients were included for analysis. CPAP treatment led to a significant reduction in haemoglobin A1c (HbA1c) (mean difference -0.24%, 95% CI -0.43- -0.06%, p=0.001) compared to inactive control groups. Meta-regression showed a significant association between reduction in HbA1c and hours of nightly CPAP usage. CPAP therapy seems to significantly improve HbA1c and thus long-term glycaemic control in patients with type 2 diabetes and obstructive sleep apnoea. The amount of improvement is dependent on the hours of usage of CPAP and thus optimal adherence to CPAP should be a primary goal in these patients.

Differences In HbA1c Levels In Diabetes Mellitus Patients Using Capillary And Venous blood Samples

Introduction: HbA1c is a non-enzymatic binding of glucose molecules to hemoglobin through a post- translational glycation process, measuring the level or percentage of glucose bound to hemoglobin, this parameter is used as the main benchmark for controlling Diabetes Mellitus because HbA1c can describe blood sugar levels within a period of 1- 3 months due to red blood cells bound by glucose molecules. HbA1c examination is an examination of glycemic levels which is useful to determine long-term glycemic control in patients with Diabetes Mellitus. From this study to determine differences in HbA1c levels in diabetes mellitus patients using capillary and venous blood samples. Method: Cross-sectional, this research was conducted at the Hematology Laboratory of the Palembang Muhammadiyah Institute of Health and Technology. The population taken was Diabetes Mellitus Patients in the Muhammadiyah Palembang Hospital laboratory. The sample used in this study was 29 samples using purposive sampling. Results: The average HbA1c level was found in 7.91% capillary blood and 7.91% venous blood. Discussion: The conclusion in this study is that capillary and venous blood sampling can be used to check HbA1c levels.

Venom Peptides, Polyphenols and Alkaloids: Are They the Next Antidiabetics That Will Preserve β-Cell Mass and Function in Type 2 Diabetes?

Improvement of insulin secretion by pancreatic β-cells and preservation of their mass are the current challenges that future antidiabetic drugs should meet for achieving efficient and long-term glycemic control in patients with type 2 diabetes (T2D). The successful development of glucagon-like peptide 1 (GLP-1) analogues, derived from the saliva of a lizard from the Helodermatidae family, has provided the proof of concept that antidiabetic drugs directly targeting pancreatic β-cells can emerge from venomous animals. The literature reporting on the antidiabetic effects of medicinal plants suggests that they contain some promising active substances such as polyphenols and alkaloids, which could be active as insulin secretagogues and β-cell protectors. In this review, we discuss the potential of several polyphenols, alkaloids and venom peptides from snake, frogs, scorpions and cone snails. These molecules could contribute to the development of new efficient antidiabetic medicines targeting β-cells, which would tackle the progression of the disease.

An Integrated Management of Type-2 Diabetes Mellitus associated with Hypertension and Dyslipidemia with Naturopathy and Yoga: A Case Report

The whole practice of nature cure is based on the following three principles: Accumulation of morbid matter, the abnormal composition of blood & lymph lowered vitality. Nature cure believes that all diseases arise due to the accumulation of morbid matter in the body and if the scope is given for its removal, it provides a cure or relief. It is believed that the human body possesses inherent self-constructing and self-healing powers. The blood pressure and blood sugar significantly reduce and the lipid profile also improves due to the influence of yoga practices and naturopathic management. Lifestyle is an important risk factor for increasing the prevalence of diabetes in the Indian population. In this study, we evaluated the effects of naturopathy treatment, salt-restricted low-calorie diets, and yoga in long-term glycemic control in patients with type 2 diabetes mellitus.

What are the factors associated with long-term glycaemic control in patients with type 2 diabetes and elevated glycated haemoglobin (≥7.0%) at initiation of second-line therapy? Results from the DISCOVER study.

Glycaemic control is a cornerstone of type 2 diabetes (T2D) management. We assessed factors associated with good long-term glycaemic control in patients with glycated haemoglobin (HbA1c) ≥7.0% at initiation of second-line glucose-lowering therapy, using data from DISCOVER, a global, prospective, 3-year observational study of patients with T2D. This analysis included patients with HbA1c ≥7.0% at baseline (initiation of second-line therapy). Multivariable regression models assessed factors associated with having HbA1c <7.0% at 3 years in two distinct groups: patients with (a) HbA1c ≥7.0% and <9.0%, and (b) HbA1c ≥9.0% at baseline. In total, 7575 patients with baseline HbA1c ≥7.0% were included (2233 with baseline HbA1c ≥9.0%). At 6 months, 43.7% and 24.2% of patients had an HbA1c level <7.0% in groups a and b, respectively; the corresponding proportions at 3 years were 45.8% and 29.3%. Having HbA1c <7.0% at 6 months (vs. ≥7.0%) was the strongest predictor of having HbA1c <7.0% at 3 years in both group a and group b [odds ratio (95% confidence interval): 2.01 (1.77-2.27) and 2.68 (2.10-3.41), respectively]. Longer T2D duration was associated with a decreased likelihood of having HbA1c <7.0% at 3 years. In patients with poor glycaemic control at initiation of second-line therapy, early attainment of HbA1c <7.0% appears predictive of long-term glycaemic control, suggesting that timely modification of treatment strategies in patients with elevated HbA1c after 6 months is important to minimize therapeutic inertia.

Effect of an Integrated Naturopathy and Yoga Program on Long-Term Glycemic Control in Type 2 Diabetes Mellitus Patients: A Prospective Cohort Study.

Aim:Lifestyle is an important risk factor for increasing the prevalence of diabetes in the Indian population. In this study, we evaluate the effects of naturopathy treatment, salt-restricted low-calorie diets, and yoga in long-term glycemic control in patients with type 2 diabetes mellitus.Methods:In this prospective, longitudinal, two-arm cohort study, patients with type 2 diabetes mellitus referred from a tertiary care center undergoing a 3-month residential naturopathy treatment were compared with those undergoing only conventional management on glycemic control. Both fasting and postprandial blood glucose (PPBG) levels were assessed at baseline, 3 months following intervention, at 6 months, and 12 months from the study start. Data were analyzed using repeated-measures ANOVA with post hoc Bonferroni correction.Results:Naturopathy and yoga intervention significantly reduced PPBG levels (P < 0.001), glycated hemoglobin levels (P < 0.001), and reduced requirement for antidiabetic medications (P < 0.008) in the intervention group compared to controls. The effects were more profound immediately following intervention and lasted up to 6 months from the start of the study.Conclusion:The results suggest benefit with an intensive residential naturopathy-based lifestyle intervention program. Randomized controlled trials are needed to further validate the findings.

Relationship Between Morbidity and Mortality and HbA1c Levels in Diabetic Patients Undergoing Major Surgery

To investigate the relationship between the preoperative HbA1c levels and the complications and mortality rates in the postoperative period in patients with diabetes undergoing a major surgical treatment. Descriptive study Place and Duration of Study: Deparment of Internal Medicine, Adana Numune Research and Training Hospital, Turkey, from January 2015 to December 2016. Diabetic patients, who underwent major surgery (a large resection) having preoperative HbA1c levels, were considered. A total of 1,013 patients, whose file data were completely accessed, were included in the study. Preoperative HbA1c levels of the patients and complications seen within the first 7 and first 30 days postoperatively were recorded. Fourty-nine (4.8%) of the patients were exitus in the hospital, while 964 (95.2%) of the patients were discharged. Preoperative HbA1c levels of the patients were found to be predictive marker of mortality and complications in the first 7 and 30 days postoperatively (p <0.001). HbA1c levels are important in preoperative surgical risk assessment in diabetic patients. Better provision of long-term glycemic control in patients planned elective surgery and have low levels of HbA1c may significantly reduce postoperative mortality and complications.

Sustained Improvements in Glucose Metabolism Late After Roux-En-Y Gastric Bypass Surgery in Patients with and Without Preoperative Diabetes

To describe glucose metabolism in the late, weight stable phase after Roux-en-Y Gastric Bypass (RYGB) in patients with and without preoperative type 2 diabetes we invited 55 RYGB-operated persons from two existing cohorts to participate in a late follow-up study. 44 (24 with normal glucose tolerance (NGT)/20 with type 2 diabetes (T2D) before surgery) accepted the invitation (median follow-up 2.7 [Range 2.2–5.0 years]). Subjects were examined during an oral glucose stimulus and results compared to preoperative and 1-year (1 y) post RYGB results. Glucose tolerance, insulin resistance, beta-cell function and incretin hormone secretion were evaluated. 1 y weight loss was maintained late after surgery. Glycemic control, insulin resistance, beta-cell function and GLP-1 remained improved late after surgery in both groups. In NGT subjects, nadir glucose decreased 1 y after RYGB, but did not change further. In T2D patients, relative change in weight from 1 y to late after RYGB correlated with relative change in fasting glucose and HbA1c, whereas relative changes in glucose-stimulated insulin release correlated inversely with relative changes in postprandial glucose excursions. In NGT subjects, relative changes in postprandial nadir glucose correlated with changes in beta-cell glucose sensitivity. Thus, effects of RYGB on weight and glucose metabolism are maintained late after surgery in patients with and without preoperative T2D. Weight loss and improved beta-cell function both contribute to maintenance of long-term glycemic control in patients with type 2 diabetes, and increased glucose stimulated insulin secretion may contribute to postprandial hypoglycemia in NGT subjects.

A multicentre prospective observational study of the prevalence and glycaemic control of diabetes mellitus in adult non-cardiac elective surgical patients in hospitals in Western Cape Province, South Africa.

Diabetes mellitus (DM) is a common condition. The high burden of undiagnosed DM and a lack of large population studies make accurate prevalence estimations difficult, especially in the surgical environment. Furthermore, poorly controlled DM is associated with an increased risk of perioperative complications and mortality. The primary objective was to establish the prevalence of DM in elective adult non-cardiac, non-obstetric surgical patients in hospitals in Western Cape Province, South Africa. The secondary objectives were to assess the glycaemic control and compliance with treatment of known diabetics. A 5-day multicentre, prospective observational study was performed at six government-funded hospitals in the Western Cape. Screening for DM was done using finger-prick capillary blood glucose (CBG) testing. Patients found to have a CBG ≥6.5 mmol/L had their glycated haemoglobin (HbA1c) level measured. DM was diagnosed based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) diagnostic criteria. Patients known to have DM had their HbA1cmeasured and completed a Morisky Medication Adherence Scale (MMAS-4) questionnaire to assess glycaemic control and compliance with treatment. Of the 379 participants, 61 were known diabetics (16.2%; 95% confidence interval (CI) 12.4 - 19.8). After exclusion of 8 patients with incomplete results, a new diagnosis of DM was made in 5/310 patients (1.6%; 95% CI 0.2 - 3.0). The overall prevalence of DM was 17.8% (66/371; 95% CI 13.9 - 21.7). HbA1c results were available for 57 (93.4%) of the 61 known diabetics. Of these, 27 (47.4%; 95% CI34.4- 60.3) had an HbA1c level ≥8.5% and 14 (24.6%; 95% CI 13.4 - 35.8) had a level ≤7%. Based on positive responses to two or more questions on the MMAS-4 questionnaire, 12/60 participants (20.0%) were deemed non-compliant. There is a low rate of undiagnosed DM in our elective surgical population, but in a high proportion of patients with DM the condition is poorly controlled. Poorly controlled DM is known to increase postoperative complications and is likely to increase the burden of perioperative care. Resources should be focused on improvement of long-term glycaemic control in patients presenting for elective surgery.

Effect of Hypoglycemia during Intensive Insulin Therapy on Long-Term Glycemic Control in Patients with Newly Diagnosed Type 2 Diabetes

Aims: Short-term intensive insulin therapy induces long-term drug-free euglycemic remission in half of patients with newly diagnosed type 2 diabetes mellitus (T2DM) but causes an increased risk of hypoglycemia. Studies identifying the impact of hypoglycemia are necessary. Methods: We analyzed data from three randomized prospective trials conducted at our institution from 2002 to 2015. A continuous subcutaneous insulin infusion (CSII) was provided to achieve the glycemic goals and then maintained for 14 days. Results: Patients who attained one-year drug-free glycemic remission were younger (48.06±9.85 vs. 50.95±11.70 years, P=0.037) and had a higher body mass index (BMI) (25.53±3.52 vs. 24.66±3.20 kg/m2, P=0.046) than those who did not. Notably, the median number of episodes of mild hypoglycemia with nadir glucose values of 3.0-3.9 mmol/L was higher in the remission group than in the non-remission group (5 (6) vs. 2 (5), P&amp;lt;0.001). However, the number of episodes of clinically significant hypoglycemia (&amp;lt;3.0 mmol/L) was insignificantly lower in the remission group (0 (1) vs. 0 (1), P=0.273). Patients with higher glucose levels (glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG)) and lower ?-cell functions (homeostasis model assessment of ?-cell function (HOMA-B)) at baseline faced a greater risk of clinically significant hypoglycemia (OR=2.02, 95% CI 1.40-2.92, P&amp;lt;0.001). According to the logistic regression analysis, mild hypoglycemic episodes were positively and independently related to long-term glycemic remission. Conclusions: Mild hypoglycemic episodes during CSII therapy are related to better long-term drug-free glycemic remission in patients with newly diagnosed T2DM. However, clinically significant hypoglycemia is not correlated and should be avoided. Disclosure L. Xu: None. Y. Li: None.

Continued Follow-Up by a Hospital Diabetes Care Team Improves HbA1c at 1 Year after Elective Orthopedic Surgery

Hospitalization is considered an opportunity to improve long-term glycemic control in patients with poor glycemic control at the time of admission. Previous studies have shown an improvement in HbA1c at 3 months, followed by deterioration at 1 year after discharge. In a randomized controlled trial of patients with high HbA1c (≥8%) undergoing an elective surgery, we found that continued care (CC) by a hospital diabetes care team as compared to the usual care (UC) had no significant effect on HbA1c at 1 year after discharge. Here, we present a secondary analysis of these data to evaluate the effect of type of surgery on our outcomes. We hypothesized that patients undergoing an orthopedic surgery may have a higher reduction in HbA1c in response to our intervention. Out of 151 patients, 35 patients had undergone an orthopedic surgery, 18 in the CC group and 17 in the UC group. Baseline characteristics and clinical outcomes are shown in Table 1. Patients undergoing an orthopedic surgery had a significant reduction in HbA1c in the CC group while those in the UC group had no change at one year. In contrast, patients undergoing a non-orthopedic elective surgery had similar reduction in HbA1c in the CC and UC groups. These data suggest that the effect of intervention to improve long-term glycemic control after discharge from the hospital is affected by the hospital diagnosis.Table 1. Patient characteristics and clinical outcomes.Orthopedic SurgeryNon-orthopedic SurgeryVariableCC groupN=18UC groupN=17P valueCC groupN=59UC groupN=57P valueAge, years67±764±110.3764±1062±100.28Female Gender6 (33)4 (23)0.5129 (49)21 (37)0.18White Race18 (100)15 (88)0.1355 (93)55 (96)0.40Duration of diabetes, years12.4±10.612.8±6.70.9111.2±8.212.2±9.80.55BMI, kg/m234.7±8.638.0±13.00.3935.2±8.533.5±8.10.31Serum Creatinine, mg/dL0.86±0.150.88±0.240.851.1±0.61.1±0.50.90eGFR, mL/min58.5±3.459.3±5.40.8855.0±11.055.5±9.70.82Baseline HbA1c8.5±0.48.9±0.70.039.0±1.19.2±1.20.25HbA1c at 1-year after discharge7.8±1.08.9±1.30.018.3±1.48.4±1.50.76Change in HbA1c at 1-year from baseline0.7±0.90.0±1.20.050.7±1.50.9±1.60.56Data are presented as mean with SD for continuous variables and N with % for categorical variables. Disclosure R. Garg: None. S. Bhandari: None. R. Rein: None. M.E. McDonnell: None.

Diabetes and Hyperglycemia in Lower-Extremity Total Joint Arthroplasty: Clinical Epidemiology, Outcomes, and Management.

* Diabetes mellitus is prevalent among patients undergoing lower-extremity total joint arthroplasty, occurring in upwards of 20% of patients undergoing arthroplasty, and nondiabetic stress-induced hyperglycemia may be seen in &gt;50% of patients undergoing arthroplasty.* Poor glycemic control including elevated hemoglobin A1c (HbA1c) in patients with diabetes and elevated plasma glucose levels in patients without diabetes correlate with worse surgical and medical outcomes in patients undergoing total joint arthroplasty, but may have limited predictive value in individual patients.* Available outcomes literature suggests that efforts to achieve HbA1c below 6.5% to 7.5% preoperatively may maximize access to total joint arthroplasty while limiting excess morbidity; this generally aligns with most medical guidelines’ recommendations with regard to long-term glycemic control in patients with diabetes.* Most patients with type-2 diabetes undergoing total joint arthroplasty should be treated perioperatively with a weight-based basal-bolus insulin regimen instead of sliding-scale monotherapy targeting moderate (generally defined as &lt;180 mg/dL in nonfasting patients) and not overly strict glycemic control. Oral hypoglycemic agents may convey specific risks in the perioperative period.* Future prospective studies evaluating preoperative and perioperative glycemic control strategies for patients with and without diabetes are needed to assess whether clinically meaningful outcomes might be improved by implementing these strategies.

Original diabetes education program including individual self-care plan “My Goals Sheet” ameliorates long-term glycemic control in patients with diabetes mellitus

Original diabetes education program including individual self-care plan “My Goals Sheet” ameliorates long-term glycemic control in patients with diabetes mellitus

Should haemoglobin A1C be used for diagnosis of diabetes mellitus in Malawi?

Glycated haemoglobin (haemoglobin A1c or HbA1c) level has long been utilised for assessment of long-term glycaemic control in patients with diabetes mellitus.1 More recently it has also been included as a criterion for the diagnosis of type 2 diabetes mellitus.2 However, use of HbA1c as a diagnostic tool for diabetes is controversial.3 This article discusses some of the limitations, and explores whether HbA1c should be recommended for diagnosis of diabetes mellitus in Malawi and similar settings.

C-Peptide Level in Fasting Plasma and Pooled Urine Predicts HbA1c after Hospitalization in Patients with Type 2 Diabetes Mellitus.

In this study, we investigate how measures of insulin secretion and other clinical information affect long-term glycemic control in patients with type 2 diabetes mellitus. Between October 2012 and June 2014, we monitored 202 diabetes patients who were admitted to the hospital of Asahi Life Foundation for glycemic control, as well as for training and education in diabetes management. We measured glycated hemoglobin (HbA1c) six months after discharge to assess disease management. In univariate analysis, fasting plasma C-peptide immunoreactivity (F-CPR) and pooled urine CPR (U-CPR) were significantly associated with HbA1c, in contrast to ΔCPR and C-peptide index (CPI). This association was strongly independent of most other patient variables. In exploratory factor analysis, five underlying factors, namely insulin resistance, aging, sex differences, insulin secretion, and glycemic control, represented patient characteristics. In particular, insulin secretion and resistance strongly influenced F-CPR, while insulin secretion affected U-CPR. In conclusion, the data indicate that among patients with type 2 diabetes mellitus, F-CPR and U-CPR may predict improved glycemic control six months after hospitalization.

Self-control – once more about the most important things

Diabetes mellitus (DM) is a complex disease the key component of which is dysglycemia leading to development of late complications. The necessary condition to achieve the glycemic control in conditions of day-to-day life is blood glucose self￾control. But for the team doctor-patient determination of the self-control aim is not a simple task. For its solution a variety of randomized controlled studies were conducted and their analysis provoked a number of new issues. The indisputable fact is that self-control helps in achievement of the long-term glycemic control in patients of DM2, contributes to prevention of acute and late diabetic complications development.

Evaluation of fixed dose combination of glimepiride and metformin in patients with type 2 diabetes. Results of Russian observational study

Aim. To investigate the efficacy and safety of combined glimepiride and metformin therapy in patients with type 2 diabetes mellitus (T2DM). Materials and methods. A multi-centre, open-label, prospective, observational study was conducted. A total of 1200 patients with T2DM inadequately controlled with metformin, glimepiride or combination of metformin + glimepiride were enrolled. Change in serum glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial blood glucose (PPG) levels; weight; waist circumference and hypoglycemic episodes were evaluated. Results. Baseline HbA1c levels (8.24% ? 0.42%) were significantly reduced after 12 weeks of treatment (7.48% ? 0.48%) and at the end of the study. (6.88% ? 0.56%). Target HbA1c levels (?7%) were achieved in 65.1% of patients at the final visit at 24 weeks. FPG and PPG levels decreased by 1.45 ? 1.14 mmol/l and 2.17 ? 1.27 mmol/l respectively (p &lt; 0.001). No severe hypoglycemic events were reported. Body mass index reduced by 0.85 ? 1.28 kg/m2 (p &lt; 0.001). Conclusion. . Combined glimepiride and metformin therapy significantly improved long-term glycemic control in patients with T2DM during the period of 24 weeks. without additional risk of hypoglycemic events or weight gain.

GLP-1 Receptor Agonists for Type 2 Diabetes Mellitus: Recent Developments and Emerging Agents

More than 26 million people in the United States have type 2 diabetes mellitus (T2D). Many treatment options exist, but achieving long-term glycemic control in patients with T2D remains challenging. The glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer a treatment option that improves glycemic control and reduces weight, with a low risk of hypoglycemia. They have emerged as attractive options for the treatment of T2D, and significant advances and developments continue to be published regarding these agents. To identify relevant literature on emerging issues related to GLP-1 RAs, a search of the MEDLINE database was performed. Studies published in English evaluating the safety and efficacy of GLP-1 RAs were analyzed. Because of their advantages and unique mechanism of action, GLP-1 RAs are currently being studied in new clinical areas, including in combination with basal insulin, as adjunctive therapy in type 1 diabetes, and for weight loss. In addition, there are several emerging agents in development. Lixisenatide is a once-daily GLP-1 RA that targets postprandial glucose and may be most useful when added to basal insulin as an alternative to rapid-acting insulin. Albiglutide and dulaglutide are once-weekly GLP-1 RAs that may offer more convenient dosing. The most common adverse effects of all GLP-1 RA agents are gastrointestinal (e.g., nausea, diarrhea, and vomiting), but the rates of occurrence vary among agents. Due to the differences in pharmacokinetics, efficacy, rates of adverse effects, and administration requirements within the GLP-1 RA class, each agent should be evaluated independently. The future of GLP-1 RAs offers broader treatment options for T2D as well as potential in other treatment areas.

Abstract 4: Recognition of Newly-Diagnosed Diabetes Mellitus During an Acute Myocardial Infarction

Background: Diabetes mellitus (DM) is a common comorbidity in patients hospitalized with an acute myocardial infarction (AMI), and, in some cases, the AMI hospitalization represents the first opportunity to recognize and treat DM. We sought to understand both the prevalence of incident DM and its rate of recognition among AMI patients without DM diagnosis on admission. Methods: Patients in a 24-site U.S. AMI registry had A1C assessed at a core lab, which was blinded to clinicians. Patients could also have A1C drawn for clinical purposes. We defined DM based on A1C≥6.5% or, if A1C level was missing, based on ≥2 fasting glucose levels ≥126 mg/dL or ≥1 fasting glucose ≥126 mg/dL AND glucose at presentation ≥200 mg/dL. DM was considered recognized if the patient received DM education during the hospitalization or a DM medication at discharge. Multivariable, hierarchical logistic regression examined factors associated with recognition. Treatment with DM medications was evaluated at 6-months after discharge. Results: Among 2854 AMI patients without known DM on admission, 287 patients (10.1%) had core lab-diagnosed DM. Among these, 198 (69%) were not recognized by the treating physicians. Median A1C of unrecognized patients was 6.7%, range of 6.5-12.3%. If the treating physician checked an A1C during the AMI, this was associated with a 17-fold increased odds of recognition (95% CI 6.0-50.2). Furthermore, if the A1C was checked and was ≥7% (vs. &lt;7%), this was also associated with 17-fold increased odds of DM recognition (95% CI 6.3-47.1). Six months after discharge, only 6.8% of those not recognized as having DM during hospitalization had been initiated on DM medications vs. 71% of those recognized during the AMI (p&lt;0.001). Discussion: Among AMI patients without known DM, 1 in 10 have underlying DM. Recognition of this remains sub-optimal, with fewer than 1 in 3 patients receiving DM education or medications at discharge. The majority of unrecognized patients are not initiated on therapy during follow-up, emphasizing the importance of recognition during the AMI hospitalization. Furthermore, the strongest predictor of recognition was A1C assessment during hospitalization, highlighting an important opportunity to improve the recognition of DM and, possibly, long-term glycemic control in patients hospitalized with AMI.