Heart-Attack Patients Should Be Tested, Treated for Diabetes

Marcia Frellick

November 12, 2015

ORLANDO, Florida — Diagnosing and treating myocardial infarction (MI) patients who have diabetes can substantially improve cardiac-related outcomes, new research indicates.

People who present to emergency departments with acute MI often also have diabetes, which puts them at greater risk for repeat MIs, heart failure, and stroke.

But often that diabetes has gone undiagnosed or is diagnosed on admission but not treated, Viet Le, MPAS, PA-C, a researcher with Intermountain Medical Center in Salt Lake City, Utah, and colleagues explained in a poster presented November 8 here at the American Heart Association (AHA) 2015 Scientific Sessions.

The researchers studied nearly 6000 patients treated for MI between 2002 and 2013 by Intermountain clinicians, of whom 3778 had no history of diabetes before admission. Among those, researchers identified 707 who met criteria for a diabetes diagnosis on admission. But of the 707, only 30% were clinically diagnosed in the hospital and treated immediately.

The remainder who were not diagnosed but met the criteria for a diabetes diagnosis were found to have 1.5 times the risk of a major adverse cardiac event (MACE) 1 year after discharge (odds ratio [OR], 1.5; 95% CI 1.3–1.7; P < .0001) compared with those with no history of diabetes.

But that risk is tempered if diagnosis is made at the time of the acute MI, the researchers found. There was no significant difference in MACE between those with diabetes diagnosed at the time of heart attack and those without diabetes (OR, 1.3; P = .15).

Criteria for diagnosing diabetes were a fasting glucose of at least 126 mg/dL, a random glucose of at least 200, or an HbA1c of at least 6.5%.

"Low-Hanging Fruit"

Mr Le points out that clinicians are missing an opportunity to find and treat diabetes when people present with a heart attack. "They are low-hanging fruit," he told Medscape Medical News.

He recommends that emergency-department clinicians check all patients coming in with a heart attack for diabetes. If diabetes is confirmed, treatment for diabetes should begin immediately.

He says he's not advocating for overly aggressive, strict diabetic control for those newly diagnosed in the emergency department, but just starting glucose control.

"Their A1cs are in the 8, 9, and 10 range. Just bringing them closer to normal should improve their health," he commented.

Lack of Awareness; Check Can Be Standard

Testing for diabetes often just isn't on clinicians' radar as they are dealing with the urgency of the heart attack, but Mr Le notes that the check can be done simply by adding a request for an HbA1c level from the blood sample already drawn in the emergency department.

Lack of awareness, rather than lack of time or funding, is keeping these tests from being done, Mr Le explains.

"We say if you have diabetes, you're at risk for coronary disease, but we forget that if you've had a heart attack, you're probably at risk for having diabetes," he said. "We don't look at it from that viewpoint."

Protocols for more aggressive identification of incident diabetes should be instituted and may importantly affect clinical outcomes for patients with previously undiagnosed diabetes, he and his team conclude.

The next step is getting the research published and then moving from a retrospective review to prospective studies, he added.

Le declared no relevant financial relationships.

American Heart Association 2015 Scientific Sessions. Presented November 8, 2015.


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