Seven-year mortality in heart failure patients with undiagnosed diabetes: an observational study

Abstract

BackgroundPatients with type 2 diabetes mellitus and heart failure have adverse clinical outcomes, but the characteristics and prognosis of those with undiagnosed diabetes in this setting has not been established.MethodsIn total, 400 patients admitted consecutively with acute heart failure were grouped in three glycaemic categories: no diabetes, clinical diabetes (previously reported or with hypoglycaemic treatment) and undiagnosed diabetes. The latter was defined by the presence of at least two measurements of fasting plasma glycaemia ≥ 7 mmol/L before or after the acute episode.Group differences were tested by proportional hazards models in all-cause and cardiovascular mortality during a 7-year follow-up.ResultsThere were 188 (47%) patients without diabetes, 149 (37%) with clinical diabetes and 63 (16%) with undiagnosed diabetes. Patients with undiagnosed diabetes had a lower prevalence of hypertension, dyslipidaemia, peripheral vascular disease and previous myocardial infarction than those with clinical diabetes and similar to that of those without diabetes. The adjusted hazards ratios for 7-year total and cardiovascular mortality compared with the group of subjects without diabetes were 1.69 (95% CI: 1.17-2.46) and 2.45 (95% CI: 1.58-3.81) for those with undiagnosed diabetes, and 1.48 (95% CI: 1.10-1.99) and 2.01 (95% CI: 1.40-2.89) for those with clinical diabetes.ConclusionsUndiagnosed diabetes is common in patients requiring hospitalization for acute heart failure. Patients with undiagnosed diabetes, despite having a lower cardiovascular risk profile than those with clinical diabetes, show a similar increased mortality.

Prevalence of Undiagnosed Type 2 Diabetes Mellitus and Its Associated Factors Among the Malaysian Population: The 2015 National Health and Morbidity Survey, Malaysia

“…Although the prevalence of 9.2% is lower compared to some Southeast Asian countries; 11.1% in Tamil Nadu (Subramani, Devi, & Shankar, 2014) and 11.1% in Singapore (Huang et al, 2015) but it is nonetheless significantly higher compared to other countries like Canada (2.2%) (Flores-Le Roux et al, 2011) and the United Kingdom (2.0%) (Moody, Cowley, Ng Fat, & Mindell, 2016). These undiagnosed DM in Malaysia could be due to lack of awareness of the necessity of health screening at an earlier age and of early diabetes symptoms.…”

Elevated serum glucose levels and survival after acute heart failure: A population-based perspective

“…11,12 Among patients with heart failure, DM is associated with increased mortality. 13,14 Reduced survival among patients with heart failure and DM is, in part, attributable to the presence of hyperglycaemia, which has been associated with an increased risk of cardiovascular events, heart failure-related hospitalizations and total mortality. 10,[13][14][15] Despite an increased risk of dying among heart failure patients with DM, 16,17 the health-care practices in those with and without DM may be similar.…”

“…13,14 Reduced survival among patients with heart failure and DM is, in part, attributable to the presence of hyperglycaemia, which has been associated with an increased risk of cardiovascular events, heart failure-related hospitalizations and total mortality. 10,[13][14][15] Despite an increased risk of dying among heart failure patients with DM, 16,17 the health-care practices in those with and without DM may be similar. 3,[10][11][12] Furthermore, long-term mortality has been shown to be similar among both diagnosed and undiagnosed diabetics with hyperglycaemia.…”

“…3,[10][11][12] Furthermore, long-term mortality has been shown to be similar among both diagnosed and undiagnosed diabetics with hyperglycaemia. 14,15 Limited data also exist to suggest that elevated serum glucose level at the time of hospital presentation, in the absence of a history of DM, may be an important prognostic factor in patients with an acute exacerbation of heart failure.…”

Assessment of risk of developing type 2 diabetes mellitus in urban slums of central India: a community based cross sectional study

“…[4][5][6] Those who are not diagnosed of DM will not take steps to manage their blood glucose or change their life styles.…”