10例心脏意外患者中有1例患有未经诊断的糖尿病

密苏里州堪萨斯市Saint Luke’s Mid美洲心脏研究所心脏病专家Suzanne V. Arnold医生在美国心脏协会诊疗质量和结局研究会议上报告，急性心肌梗死（MI）患者10%在发生心脏意外时有未诊断的糖尿病。这一结果凸显了在此类患者住院期间进行糖尿病评估的重要性。

该研究数据来自美国24个中心的急性MI注册中纳入的2,854例住院时未知有2型糖尿病患者。糖尿病的诊断是基于糖化血红蛋白（HbA_1c）水平≥6.5%。如未能获取HbA_1c结果，则诊断是基于至少两次空腹血糖水平≥126 mg/dl，或至少一次空腹血糖水平≥126 mg/dl加就诊时随机血糖≥200 mg/dl。

结果发现，在这2,854例患者中，有287例（10.1%）实际患有2型糖尿病。在研究中确定有未经诊断的糖尿病的287例患者中，接近70%（198例）在住院期间未被主治医生诊断为糖尿病。将患者在住院期间未接受关于糖尿病的教育或出院时未处方治疗糖尿病的药物作为未诊断的提示。但如医生在常规临床诊疗中检测急性MI患者的HbA_1c，则患者被诊断为糖尿病的几率将增加18倍，这是一个有高度统计学意义的结果。

Arnold医生披露无相关利益冲突。这项注册研究为TRIUMPH（关于急性心肌梗死患者基础健康状况差异的转化研究）研究，该研究由国立卫生研究院/国立心肺血液研究所资助。基因泰克公司资助了对TRIUMPH注册数据的分析。

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By: ELIZABETH MECHCATIE, Cardiology News Digital Network

Jun 4, 2014

Ten percent of patients presenting with an acute myocardial infarction had undiagnosed diabetes at the time of their heart attack, underlining the importance of evaluating such patients for diabetes while they are hospitalized, investigators have reported.

The study found that 287 (10.1%) of the 2,854 patients enrolled in a 24-site U.S. acute MI registry, who were not known to have type 2 diabetes on admission, actually had diabetes, reported Dr. Suzanne V. Arnold, a cardiologist at Saint Luke’s Mid America Heart Institute, Kansas City, Mo. The data were presented at the American Heart Association’s Quality of Care and Outcomes Research conference.

The diabetes diagnosis was based on hemoglobin A_1c levels of 6.5% or higher. If no HbA_1c result was available, the diagnosis was based on at least two fasting glucose levels of 126 mg/dL or higher, or at least one fasting glucose level of 126 mg/dL or higher plus a glucose level at presentation of at least 200 mg/dL.

Of the 287 patients who were identified as having unrecognized diabetes in the study, almost 70% (198) had not been diagnosed by the physician who treated them during their hospitalization. This lack of a diagnosis was indicated by patients not having received education about diabetes while hospitalized or not being discharged with a diabetes medication.

If a physician checked the HbA1c for a patient with an acute MI as part of routine clinical care, however, the likelihood that the patient would be diagnosed with diabetes was increased 18-fold, a highly statistically significant finding, Dr. Arnold said.

Dr. Arnold had no disclosures.

The registry study is the TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status) study and is sponsored by the National Institutes of Health/the National Heart Lung and Blood Institute. Genentech funded this analysis of the TRIUMPH registry data.