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Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute
Mikhail Kosiborod1, Silvio E Inzucchi, Abhinav Goyal
1Mid America Heart Institute of Saint Luke's Hospital, 4401 Wornall Rd, Kansas City, MO 64111, USA. mkosiborod@cc-pc.com
JAMA
|April 16, 2009
Summary
Hypoglycemia in acute myocardial infarction (AMI) patients increases mortality risk, but only when it occurs spontaneously. Insulin therapy-induced hypoglycemia in AMI patients does not appear to increase mortality risk.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Glucose control is recommended for hyperglycemic patients with acute myocardial infarction (AMI).
- Concerns about hypoglycemia temper enthusiasm for glucose lowering in AMI patients.
- The mortality risk of hypoglycemia induced by glucose-lowering therapy in AMI patients remains unclear.
Purpose of the Study:
- To compare the mortality risk of spontaneous hypoglycemia versus insulin therapy-induced hypoglycemia in hospitalized AMI patients.
- To investigate the association between hypoglycemia and in-hospital mortality in AMI patients treated with or without insulin.
Main Methods:
- Retrospective cohort study utilizing the Health Facts database (2000-2005).
- Included 7820 hyperglycemic patients hospitalized with AMI (glucose ≥ 140 mg/dL).
- Stratified patients based on occurrence of hypoglycemia (glucose < 60 mg/dL) and insulin treatment; logistic regression analyzed mortality risk.
Main Results:
- Hypoglycemia was associated with increased mortality in patients not treated with insulin (18.4% vs 9.2%, P<.001).
- Hypoglycemia was not associated with increased mortality in patients treated with insulin (10.4% vs 10.2%, P = .92).
- A significant interaction between hypoglycemia and insulin therapy was observed (P=.01), with hypoglycemia predicting higher mortality only in non-insulin-treated patients.
Conclusions:
- Hypoglycemia in AMI patients is linked to increased mortality, but this risk is specific to spontaneous hypoglycemia.
- Iatrogenic hypoglycemia resulting from insulin therapy in AMI patients did not show an association with increased mortality.
- Findings suggest that insulin therapy may mitigate the mortality risk associated with hypoglycemia in AMI patients.
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