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Relationship between glycosylated hemoglobin assessment and glucose therapy intensification in patients with diabetes hospitalized for acute myocardial infarction

Journal article
Authors J. M. Stolker
J. A. Spertus
D. K. McGuire
Marcus Lind
F. Tang
P. G. Jones
S. E. Inzucchi
S. S. Rathore
T. M. Maddox
F. A. Masoudi
M. Kosiborod
Published in Diabetes Care
Volume 35
Issue 5
Pages 991-3
ISSN 0149-5992
Publication year 2012
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 991-3
Language en
Links dx.doi.org/10.2337/dc11-1839
Keywords Acute Disease, Diabetes Mellitus/*blood/*metabolism, Hemoglobin A, Glycosylated/*metabolism, Hospitalization, Humans, Logistic Models, Myocardial Infarction/*blood/complications/*metabolism
Subject categories Clinical Medicine

Abstract

OBJECTIVE: To evaluate the relationship between A1C and glucose therapy intensification (GTI) in patients with diabetes mellitus (DM) hospitalized for acute myocardial infarction (AMI). RESEARCH DESIGN AND METHODS: A1C was measured as part of routine care (clinical A1C) or in the core laboratory (laboratory A1C, results unavailable to clinicians). GTI predictors were identified using hierarchical Poisson regression. RESULTS: Of 1,274 patients, 886 (70%) had clinical A1C and an additional 263 had laboratory A1C measured. Overall, A1C was <7% in 419 (37%), 7-9% in 415 (36%), and >9% in 315 patients (27%). GTI occurred in 31% of patients and was more frequent in those with clinical A1C both before (34 vs. 24%, P < 0.001) and after multivariable adjustment (relative risk 1.34 [95% CI 1.12-1.62] vs. no clinical A1C). CONCLUSIONS: Long-term glucose control is poor in most AMI patients with DM, but only a minority of patients undergo GTI at discharge. Inpatient A1C assessment is strongly associated with intensification of glucose-lowering therapy.

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