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The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction

OBJECTIVE: Incident diabetes mellitus (DM) is important to recognize in patients with acute myocardial infarction (AMI). To develop an efficient screening strategy, we explored the use of random plasma glucose (RPG) at admission and fasting plasma glucose (FPG) to select patients with AMI for glycos...

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Autores principales: Arnold, Suzanne V, Lipska, Kasia J, Inzucchi, Silvio E, Li, Yan, Jones, Philip G, McGuire, Darren K, Goyal, Abhinav, Stolker, Joshua M, Lind, Marcus, Spertus, John A, Kosiborod, Mikhail
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242083/
https://www.ncbi.nlm.nih.gov/pubmed/25452878
http://dx.doi.org/10.1136/bmjdrc-2014-000046
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author Arnold, Suzanne V
Lipska, Kasia J
Inzucchi, Silvio E
Li, Yan
Jones, Philip G
McGuire, Darren K
Goyal, Abhinav
Stolker, Joshua M
Lind, Marcus
Spertus, John A
Kosiborod, Mikhail
author_facet Arnold, Suzanne V
Lipska, Kasia J
Inzucchi, Silvio E
Li, Yan
Jones, Philip G
McGuire, Darren K
Goyal, Abhinav
Stolker, Joshua M
Lind, Marcus
Spertus, John A
Kosiborod, Mikhail
author_sort Arnold, Suzanne V
collection PubMed
description OBJECTIVE: Incident diabetes mellitus (DM) is important to recognize in patients with acute myocardial infarction (AMI). To develop an efficient screening strategy, we explored the use of random plasma glucose (RPG) at admission and fasting plasma glucose (FPG) to select patients with AMI for glycosylated hemoglobin (HbA1c) testing. DESIGN, SETTING, ANDPARTICIPANTS: Prospective registry of 1574 patients with AMI not taking glucose-lowering medication from 24 US hospitals. All patients had HbA1c measured at a core laboratory and admission RPG and ≥2 FPGs recorded during hospitalization. We examined potential combinations of RPG and FPG and compared these with HbA1c≥6.5%—considered the gold standard for DM diagnosis in these analyses. RESULTS: An RPG>140 mg/dL or FPG≥126 mg/dL had high sensitivity for DM diagnosis. Combining these into a screening protocol (if admission RPG>140, check HbA1c; or if FPG≥126 on a subsequent day, check HbA1c) led to HbA1c testing in 50% of patients and identified 86% with incident DM (number needed to screen (NNS)=3.3 to identify 1 case of DM; vs NNS=5.6 with universal HbA1c screening). Alternatively, using an RPG>180 led to HbA1c testing in 40% of patients with AMI and identified 82% of DM (NNS=2.7). CONCLUSIONS: We have established two potential selective screening methods for DM in the setting of AMI that could identify the vast majority of incident DM by targeted screening of 40–50% of patients with AMI with HbA1c testing. Using these methods may efficiently identify patients with AMI with DM so that appropriate education and treatment can be promptly initiated.
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spelling pubmed-42420832014-12-01 The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction Arnold, Suzanne V Lipska, Kasia J Inzucchi, Silvio E Li, Yan Jones, Philip G McGuire, Darren K Goyal, Abhinav Stolker, Joshua M Lind, Marcus Spertus, John A Kosiborod, Mikhail BMJ Open Diabetes Res Care Epidemiology/Health services research OBJECTIVE: Incident diabetes mellitus (DM) is important to recognize in patients with acute myocardial infarction (AMI). To develop an efficient screening strategy, we explored the use of random plasma glucose (RPG) at admission and fasting plasma glucose (FPG) to select patients with AMI for glycosylated hemoglobin (HbA1c) testing. DESIGN, SETTING, ANDPARTICIPANTS: Prospective registry of 1574 patients with AMI not taking glucose-lowering medication from 24 US hospitals. All patients had HbA1c measured at a core laboratory and admission RPG and ≥2 FPGs recorded during hospitalization. We examined potential combinations of RPG and FPG and compared these with HbA1c≥6.5%—considered the gold standard for DM diagnosis in these analyses. RESULTS: An RPG>140 mg/dL or FPG≥126 mg/dL had high sensitivity for DM diagnosis. Combining these into a screening protocol (if admission RPG>140, check HbA1c; or if FPG≥126 on a subsequent day, check HbA1c) led to HbA1c testing in 50% of patients and identified 86% with incident DM (number needed to screen (NNS)=3.3 to identify 1 case of DM; vs NNS=5.6 with universal HbA1c screening). Alternatively, using an RPG>180 led to HbA1c testing in 40% of patients with AMI and identified 82% of DM (NNS=2.7). CONCLUSIONS: We have established two potential selective screening methods for DM in the setting of AMI that could identify the vast majority of incident DM by targeted screening of 40–50% of patients with AMI with HbA1c testing. Using these methods may efficiently identify patients with AMI with DM so that appropriate education and treatment can be promptly initiated. BMJ Publishing Group 2014-11-04 /pmc/articles/PMC4242083/ /pubmed/25452878 http://dx.doi.org/10.1136/bmjdrc-2014-000046 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Epidemiology/Health services research
Arnold, Suzanne V
Lipska, Kasia J
Inzucchi, Silvio E
Li, Yan
Jones, Philip G
McGuire, Darren K
Goyal, Abhinav
Stolker, Joshua M
Lind, Marcus
Spertus, John A
Kosiborod, Mikhail
The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
title The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
title_full The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
title_fullStr The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
title_full_unstemmed The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
title_short The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
title_sort reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
topic Epidemiology/Health services research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242083/
https://www.ncbi.nlm.nih.gov/pubmed/25452878
http://dx.doi.org/10.1136/bmjdrc-2014-000046
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