Characteristics and management of diabetic patients hospitalized for myocardial infarction in France.
OBJECTIVE
The objective of this study was to compare the management of diabetic and non-diabetic patients before, during and after hospitalization for myocardial infarction (MI).


METHODS
Hospital admissions for MI in France from January to June 2006 were obtained from the national hospital-discharge database and merged with data on medications, 6 months before and after hospitalization of patients covered by the general health insurance scheme. Diabetic patients were identified by having at least two refunds for antidiabetic medications 6 months before the index hospitalization. Results comparing diabetic and non-diabetic patients were adjusted for age and gender.


RESULTS
Of the 14,007 patients included in the study, 2545 were diabetic (18.2%). Before hospital admission, diabetic patients more frequently received secondary cardiovascular preventative medications (12.7% vs 4.2%; P<0.0001) and stent implants (4.2% vs 2.2%; P<0.0001) than did non-diabetic patients. During hospitalization and the following month, angioplasty (56.1% vs 61.7%; P=0.0001) and stent implantation (53.3% vs 59.3%; P<0.0001) were less frequently performed in diabetic patients and only coronary angiography was done in similar proportions of diabetic and non-diabetic patients (16.7% vs 15.2%). In addition, during the 6 months after hospitalization, diabetic vs non-diabetic patients had more admissions for cardiovascular reasons (36.9% vs 29.5%; P<0.0001) and were prescribed more secondary preventative medications (65.9% vs 61.7%; P<0.0001). They were also more frequently treated with insulin only (19.6% 6 months before vs 27.2% 6 months after) or oral antidiabetic drugs (14.6% vs 19.7%, respectively) than were non-diabetics.


CONCLUSIONS
French diabetic patients subsequent to MI undergo fewer angioplasty procedures than do non-diabetic patients. After the acute stage, secondary preventative medications are used more often, with a marked rise in the use of insulin.
Tuppin
P
P
Direction de la stratégie des études et des statistiques (DSES), département des études sur les pathologies et les patients (DEPP), Caisse nationale d'assurance maladie des travailleurs salariés, 75986 Paris cedex 20, France. philippe.tuppin@cnamts.fr
Neumann
A
A
Simon
D
D
Weill
A
A
de Peretti
C
C
Danchin
N
N
Ricordeau
P
P
Allemand
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017130:Angioplasty / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D005602:France; D006761:Hospitals; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D018709:Statistics, Nonparametric
D007004:Hypoglycemic Agents