Long-Term Heart Care for Patients With and Without Diabetes

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Stranders I, Diamant M, van Gelder RE, et al.: Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Ann Intern Med 164:982-988, 2004.

What is the problem and what is known about it so far?

Having diabetes raises the risk of getting heart disease. It also raises the risk of death from a heart attack. Even people without diabetes, but with higher than normal blood glucose levels are at risk. Most research on this problem has been on the short-term effects of high blood glucose levels on heart attacks and death.

The researchers wanted to find out the long-term effects of high blood glucose levels on patients who had a heart attack. They wanted to know the difference between diabetes patients and those without diabetes, but who had high blood glucose levels when admitted to the hospital with a heart attack.

Who was studied?

846 patients admitted to the hospital because of a heart attack were studied between January 1989 and December 1996. Of these, 109 were not diagnosed with diabetes when admitted to the hospital.

How was the study done?

Researchers studied the patients' age, whether they had any previous heart attacks, were smokers,had high blood pressure and fats in the blood, and whether they had been treated for heart disease before. Blood glucose levels were checked when patients were admitted. The information was then entered into a database.

What did the researchers find?

The researchers found links between people with diabetes, older age, history of heart disease, and high blood pressure. They also found that more patients with diabetes developed heart failure when they were in the hospital than did those patients without diabetes.

On average, 43% of those with diabetes died about two years after their hospital stay. Twenty-eight percent of those without diabetes died.

What were the limitations of the study?

Because patient blood glucose levels were measured when the participants got to the hospital, it is unknown how many had eaten before. Therefore, fasting blood glucose levels, taken before a person eats, could not be known and could affect the results.

The researchers also didn't know how long patients had been diagnosed with diabetes or whether they had type 1 or type 2 diabetes.

What are the implications of the study?

Knowing the blood glucose level of patients admitted to the hospital with a heart attack is important. It helps doctors decide on medications and/or surgery for these patients and how to better treat them afterward.