Blood glucose in heart failure predicts early death and complications risk

Blood glucose in heart failure predicts early death and complications risk

The findings suggest that even if even if someone has no previous diagnosis of diabetes and has a blood glucose within the “normal” range, if their levels are above 6.1 mmol/l they are nevertheless at higher risk of developing diabetes and death. 

The researchers analysed the outcomes of 16,524 people who arrived at hospital emergency departments in Ontario, Canada, with acute heart failure between 2004 and 2007. The patients were all aged between 70 and 85, and 56% (9275) of them did not have pre-existing diabetes. Their outcomes were compared with those of a reference group of patients whose blood glucose levels ranged between 3.9-6.1 mmol/l.

The analysis showed that patients without pre-existing diabetes had a risk of dying from any cause within 30 days that was 26% higher than the reference group if their blood glucose ranged between 6.1-7.8 mmol/l. This risk was 50% greater if the level exceeded 11.1 mmol/l. Their risk of death from cardiovascular causes was also 28% higher for blood glucose levels between 6.1-7.8 mmol/l, rising to 64% higher for levels between 9.4-11.1 mmol/l.

As blood glucose levels rose, so too did the risk of subsequently developing diabetes; for levels between 6.1-7.8 mmol/l, this was 61% higher, rising by 14% for every 1 mmol/l increase in blood glucose. If levels exceeded 11.1 mmol/l, the risk of diabetes was 261% higher.

Associate Professor of Medicine, Dr Douglas Lee, who led the research, said: “Among patients without pre-existing diabetes, the majority (51%) had blood glucose levels on arrival at hospital that were within ‘normal’ limits but greater than 6.1 mmol/l.

“Our results suggest that all such patients should undergo further testing for diabetes before discharge. If the hospital tests show that their fasting blood glucose is not elevated, then they should be monitored subsequently for the development of diabetes as outpatients.”

He added: “Although diabetes is a known risk factor for developing heart failure, this is the first time that it has been shown that heart failure predisposes people to developing diabetes.”

Among the 7,249 patients with pre-existing diabetes, 2,286 (31.5%) had blood glucose levels higher than 11.1 mmol/l and their risk of death from any cause within 30 days of arriving at hospital with heart failure was increased by 48% when compared to the reference group of patients.

And they had a 39% increased risk of being admitted to hospital for diabetes-related reasons, such as hyperglycaemia, skin and soft tissue infections and amputations. Among all patients, with and without pre-existing diabetes, blood sugar levels above 9.4 mmol/l increased the risks of a hospital admission by 9-15% for heart failure or cardiovascular causes.

“Our findings suggest that the measurement of blood sugar levels in all patients arriving at emergency departments with acute heart failure could provide doctors with useful prognostic information and could help to improve outcomes in these patients,” said Dr Lee.

It is a rapid, readily available and inexpensive test that could be used to enable doctors to quickly assess a patient’s risk for a wide range of possible outcomes and to suggest appropriate screening strategies that should be put in place,” he added.

* Maneesh Sud et al. Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes. European Heart Journal, January 2015 DOI: 10.1093/eurheartj/ehu462

By Caroline White,

OnMedica, Wednesday 7 Jannuary 2015

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