Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events
Abstract
AIMS: The study evaluated the associations between glycometabolic parameters at admission and during hospitalization and 2 year all-cause mortality risk in an unselected cohort of consecutive patients with diabetes admitted for unstable angina or non-Q-wave myocardial infarction to a university hospital during 1988-98. METHODS AND RESULTS: A total of 713 consecutive patients with diabetes were included. During 2 years of follow-up, 242 (34%) patients died. All analyses were retrospective using prospectively collected clinical data. The primary study endpoint was 2 year all-cause mortality collected from the Swedish cause-specific mortality register. In unadjusted analyses, high admission blood glucose (highest vs. lowest quartile: hazard ratio (HR) 2.66; 95% confidence interval (CI) 1.83, 3.86) and hypoglycaemia recorded during hospitalization (hypoglycaemia vs. normal: HR 1.77; 95% CI 1.09, 2.86) were both significantly associated with increased 2 year all-cause mortality risk. These associations remained significant after multivariable adjustment. CONCLUSION: In the setting of acute coronary syndromes (ACS) among patients with diabetes, hyperglycaemia on arrival and hypoglycaemia during hospitalization are both independently associated with worse adjusted all-cause 2 year mortality risk. These observations suggest that the avoidance of both hyper- and hypoglycaemia during ACS events may be of similar importance, and glucose modulation remains an important objective to address in future randomized trials.
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Svensson et al found that patients with diabetes admitted for unstable angina or a non-Q wave myocardial infarction who experienced at least one episode of hypoglycaemia (blood glucose <3.06 mmol/l) during hospital admission had a higher two year mortality than those who did not experience any hypoglycaemia (HR 1.93, 95% CI 1.18 to 3.17).
“Svensson et al examined over 700 patients with diabetes admitted for unstable angina or a non-Q wave myocardial infarction and found that those who experienced at least one episode of hypoglycaemia (blood glucose <3.06 mmol/l (55 mg/dl)) during hospital admission had a higher two year mortality than those who did not experience any hypoglycaemia (HR 1.93, 95% CI 1.18 to 3.17).23”
From The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: Retrospective epidemiological analysis of the ACCORD study (2010) · cites this paper as [23]
The Patient population section reports 713 patients with diabetes admitted for unstable angina or non-Q-wave myocardial infarction. The Association between glucose parameters and 2 year mortality section reports the stated adjusted HR of 1.93 (95% CI 1.18–3.17) for patients with a documented hypoglycaemic event, but compares them with patients whose lowest glucose was 3.1–6.5 mmol/L—not with all patients who had no hypoglycaemia. Our copy provides no page numbers for these passages. (LLM, conf=0.88)
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- Authors
- Svensson, A.-M., McGuire, D. K., Abrahamsson, P., & Dellborg, M.
- Affiliations
- Sahlgrenska University Hospital (SE)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Svensson, Ann-Marie
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-04-08
- Volume
- 26
- Issue
- 13
- Pages
- 1255-1261
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2072863412
- Cited by
- 310
- References
- 3
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 11 · 2022: 3 · 2021: 6 · 2020: 15 · 2019: 9 · 2018: 7 · 2017: 6 · 2016: 15 · 2015: 19 · 2014: 19 · 2013: 18 · 2012: 27
- FWCI
- 12.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Hjärt-Lungfonden
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- hyperglycemia, hypoglycemia, all-cause mortality, diabetes mellitus, acute coronary syndrome, unstable angina, non-Q-wave myocardial infarction, admission blood glucose, glycemic control
- MeSH terms
- Aged, Angina, Unstable, Diabetic Angiopathies, Female, Hospitalization, Humans, Hyperglycemia, Hypoglycemia, Male, Myocardial Infarction, Prognosis, Prospective Studies, Sweden, Syndrome, Cohort Studies
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