title: Hypoglycemia at admission in patients with acute myocardial infarction predicts a higher 30-day mortality in patients with poorly controlled type 2 diabetes than in well-controlled patients.
abstract: OBJECTIVE
  We aimed to evaluate the association between hypoglycemia at admission and 30-day mortality in patients with acute myocardial infarction (AMI) and to determine whether these associations differed according to diabetes-control status in AMI patients with diabetes.
  
  
  METHODS
  We analyzed the prognostic significance of hypoglycemia and hyperglycemia in 34,943 AMI patients with or without type 2 diabetes from two AMI registries: the Korea Acute Myocardial Infarction Registry (KAMIR) and the Korea Working Group on Myocardial Infarction (KorMI).
  
  
  RESULTS
  The patients were divided into five groups according to serum-glucose levels at admission: <3.9 mmol/L (<70 mg/dL); 3.9-7.72 mmol/L (70-139 mg/dL); 7.78-11.06 mmol/L (140-199 mg/dL); 11.11-14.39 mmol/L (200-259 mg/dL); and ≥14.44 mmol/L (≥260 mg/dL). The 30-day mortality rates in the lowest and highest glucose groups were higher than those in other groups; the lowest glucose group had the highest mortality for patients with type 2 diabetes, after adjusting for multiple factors. We also extracted and compared four subgroups from the patients with type 2 diabetes, based on hemoglobin A1c and serum-glucose levels at admission: group A, <6.5% (48 mmol/mol) and <3.9 mmol/L; group B, <6.5% (48 mmol/mol) and ≥11.11 mmol/L; group C, ≥8% (64 mmol/mol) and <3.9 mmol/L; and group D, ≥8% (64 mmol/mol) and ≥11.11 mmol/L. Group C had the highest 30-day mortality rate among the groups.
  
  
  CONCLUSIONS
  These data suggest that hypoglycemia at admission affects clinical outcomes differently in AMI patients with type 2 diabetes depending on the diabetes-control status.
authors.affiliation: Department of Internal Medicine, Jeju National University Hospital, Jeju National School of Medicine, Jeju, Republic of Korea.
authors.forename: Sang Ah
authors.initials: SA
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology, Jeju National University Hospital, Jeju National School of Medicine, Jeju, Republic of Korea.
authors.forename: Suk Ju
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea drhormone@naver.com myungho@chollian.net.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Jeju National University Hospital, Jeju National School of Medicine, Jeju, Republic of Korea.
authors.forename: Gwanpyo
authors.initials: G
authors.lastname: Koh
authors.affiliation: Department of Public Health, Wonkwang University, Iksan, Republic of Korea.
authors.forename: Jeong Mi
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea.
authors.forename: Seok Kyu
authors.initials: SK
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea.
authors.forename: Kyeong Ho
authors.initials: KH
authors.lastname: Yun
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea.
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea.
authors.forename: Chung Gu
authors.initials: CG
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea drhormone@naver.com myungho@chollian.net.
authors.forename: Dae Ho
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000097:blood / Q000401:mortality / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy; D007003:Hypoglycemia / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin