Type of preadmission glucose-lowering treatment and prognosis among patients hospitalised with myocardial infarction: a nationwide follow-up study

Abstract

Aims/hypothesis We examined whether the type of preadmission glucose-lowering treatments explained differences in mortality rate and risk of readmission with myocardial infarction (MI) and heart failure following first-time hospitalisation for MI in patients with type 2 diabetes mellitus. Methods We conducted a nationwide population-based followup study among all Danish patients hospitalised with firsttime MI from 1996 to 2004. Data on use of glucose-lowering drugs and other medications, comorbidities, socioeconomic status, laboratory findings, readmission with MI and heart failure, and death were obtained from medical databases. We computed mortality rates and rates of MI and heart failure readmission, according to type of glucose-lowering treatment and used Cox's proportional hazards regression analysis to compute hazard ratios (HRs) as estimates of relative risks. Results We identified 8,494 MI patients with type 2 diabetes mellitus. The overall cumulative 30 day and 1 year mortality rates were 22.2 and 36.6%, respectively. Patients not receiving any glucose-lowering drugs (adjusted 30 day HR: 0.79, 95% CI: 0.57-1.10) and users of any combination (adjusted 30 day HR: 1.43, 95% CI: 0.98-2.09) had the lowest and highest mortality rates, respectively, when compared with users of sulfonylureas. We found that glycaemic control had no impact on the risk estimates in a subanalysis including biochemical laboratory data. We found no differences in the risk of new MI and heart failure between the different glucose-lowering agents. Conclusions/interpretation Type of preadmission glucoselowering treatment in monotherapy is not associated with substantial differences in prognosis following hospitalisation with MI. However, patients treated with any combination had increased mortality rates.

Effect of Second-Generation Sulfonylureas on Survival in Patients With Diabetes Mellitus After Myocardial Infarction

“…Similar concern was raised in a recent study of a large number of individuals from Denmark 31. However, other reports did not detect such an association 32-34. Differences in sample size and study design likely account for these discrepancies.…”

Predictors of 30 day hospital readmission in patients with type 2 diabetes: a retrospective, case–control, database study

“…Although different diabetic treatment regimens did not affect post-discharge outcomes in one study 23 , another study found that team interventions (i.e., a nurse educator and an endocrinologist) significantly reduced the rate of recurrent hospitalizations 24 . In patients with diabetes who were hospitalized for myocardial infarction, the type of glucose-lowering treatment received as monotherapy was not associated with differences in prognosis or readmission risk 25 .…”

Preadmission metformin use and mortality among intensive care patients with diabetes: a cohort study

“…Patients with polycystic ovarian syndrome treated with metformin and no diagnosis of diabetes were excluded (n = 19) [15]. Relevant diagnostic, laboratory, and drug codes are provided in Additional file 1.…”