title: Prevalence and clinical outcomes of undiagnosed diabetes mellitus and prediabetes among patients with high-risk non-ST-segment elevation acute coronary syndrome.
abstract: BACKGROUND
  We examined the prevalence of undiagnosed diabetes or prediabetes and associations with ischemic outcomes among non-ST-segment elevation acute coronary syndrome (ACS) patients.
  
  
  METHODS
  We categorized 8795 EARLY ACS trial patients into one of the following groups: "known diabetes" (n = 2860 [32.5%]; reported on the case report form), "undiagnosed diabetes" (n = 1069 [12.2%]; no diabetes history and fasting glucose ≥126 mg/dL or hemoglobin A1c ≥6.5%), "prediabetes" (n = 947 [10.8%]; fasting glucose ≥110 to <126 mg/dL, or "normal" (n = 3919 [44.5%]). Adjusted associations of known diabetes, undiagnosed diabetes, and prediabetes (versus normal) with 30-day and 1-year outcomes were determined.
  
  
  RESULTS
  Undiagnosed diabetes was associated with greater 30-day death or myocardial infarction (MI) (ORadj 1.28, 95% CI 1.05-1.57), driven primarily by greater 30-day mortality (ORadj 1.65, 95% CI 1.09-2.48). Known diabetic patients had 30-day death or MI outcomes similar to those of normal patients, but 30-day mortality was higher (ORadj 1.40, 95% CI 1.01-1.93). Prediabetic patients had 30-day death or MI outcomes similar to those of normal patients. One-year mortality was greater among known diabetic patients (HRadj 1.38, 95% CI 1.13-1.67) but not among those with undiagnosed diabetes or prediabetes.
  
  
  CONCLUSIONS
  Undiagnosed diabetes and prediabetes were common among high-risk non-ST-segment elevation ACS patients. Routine screening for undiagnosed diabetes may be useful since these patients seem to have worse short-term outcomes and deserve consideration of alternative management strategies.
authors.affiliation: Instituto do Coracao-Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo and the Brazilian Clinical Research Institute, São Paulo, Brazil.
authors.forename: Roberto R
authors.initials: RR
authors.lastname: Giraldez
authors.forename: Robert M
authors.initials: RM
authors.lastname: Clare
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dalby
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.forename: Gerard X
authors.initials: GX
authors.lastname: Brogan
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Tanguay
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002423:Cause of Death / Q000639:trends; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D003951:Diagnostic Errors; D004562:Electrocardiography; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011236:Prediabetic State / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin