Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Prevalence of pre-existing dysglycaemia among inpatients with acute coronary syndrome and associations with outcomes. (#61)

Dinesh Mahendran 1 , Garry Hamilton 2 , Jeremy Weiss 1 , Jeremy Lew 1 , Leonid Churilov 3 , Kaylyn Khoo 1 , Que Lam 4 , Raymond Robbins 5 , David L. Hare 2 6 , Omar Farouque 2 6 , Jeffrey Zajac 1 6 , Elif I. Ekinci 1 6
  1. Endocrinology and Diabetes, Austin Health, Heidelberg, Victoria, Australia
  2. Cardiology, Austin Health, Heidelberg, Victoria, Australia
  3. The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
  4. Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
  5. Austin centre for applied clinical informatics, Austin Health, Heidelberg, Victoria, Australia
  6. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia

Introduction

Routine HbA1c testing on admission of inpatients presenting with acute coronary syndrome (ACS) presents a unique opportunity for diagnosing pre-existing dysglycaemia without the limitations of stress-induced hyperglycaemia.

Objectives

We aimed to determine the prevalence of pre-existing dysglycaemia in inpatients presenting with ACS and its association with clinical outcomes, including acute pulmonary oedema (APO), recurrent ACS and, all-cause mortality at 12 months.

Methods

As part of the Austin Health Diabetes Discovery Initiative, routine HbA1c testing was undertaken on all inpatients aged ≥54 years admitted with ACS if none was available within the preceding 90 days. Patients were categorised into those with diabetes (prior diagnosis or HbA1c ≥ 6.5%, ≥48mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-46mmol/mol) and no diabetes (HbA1c <5.6%, <38mmol/mol).

Results

Between July 2013 and July 2015, 847 consecutive patients were admitted with ACS. 313 (37%) inpatients had diabetes, 312 (37%) had pre-diabetes and 222 (25%) had no diabetes. After adjusting for age, sex, smoking status and previous myocardial infarction, diabetes, as opposed to no diabetes, was associated with a higher risk of APO (OR 2.60, P<0.01), longer length of stay (LOS) (IRR 1.18, P=0.02) and, higher risk of 12-month ACS recurrence (OR 1.86, P<0.05). Pre-diabetes was not a statistically significant marker of adverse clinical outcomes. However, analysed as a continuous variable, HbA1c was associated with an increased risk of APO (OR 1.28, P=0.002) and, longer LOS (IRR 1.05, P=0.03).

Conclusions

In our study, three-quarters of all inpatients aged ≥54 years admitted with ACS had pre-existing dysglycaemia.  Inpatients with diabetes were at increased risk of developing APO and subsequent 12-month ACS recurrence. Increases in HbA1c, even in the pre-diabetic range, was associated with a higher risk of APO and longer LOS. Randomised studies would be necessary to determine if improving dysglycaemia in ACS patients improves longer term outcomes.

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