Structured diabetes care routines in cardiac rehabilitation are associated with increased diabetes detection and improved treatment after myocardial infarction: a nationwide observational study

• Published in: Cardiovascular diabetology 2024-09, Vol.23 (1), p.330-10, Article 330
• Main Authors: Sharad, Bashaaer, Eckerdal, Nils, Magnusson, Martin, Michelsen, Halldora Ögmundsdottir, Jujic, Amra, Lidin, Matthias, Mellbin, Linda, Shaat, Nael, Pingel, Ronnie, Wallert, John, Hagström, Emil, Leósdóttir, Margrét
• Format: Article
• Language: English
• Subjects: Aged; Basic Medicine; Biomarkers - blood; Blood Glucose - drug effects; Blood Glucose - metabolism; Cardiac Rehabilitation; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Diabetes Mellitus - therapy; Fasting; Female; Glucose; Glucose metabolism; Glucose tolerance; Glucose Tolerance Test; Glycated Hemoglobin - metabolism; Glycemic Control; Health Care Surveys; Health risks; Heart; Heart attacks; Humans; Hypoglycemic Agents - therapeutic use; Insulin; Lifestyles; Male; Marital status; Medical and Health Sciences; Medicin och hälsovetenskap; Medicinska och farmaceutiska grundvetenskaper; Metabolism; Middle Aged; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - rehabilitation; Myocardial Infarction - therapy; Neurosciences; Neurovetenskaper; Observational studies; Patients; Practice Patterns, Physicians; Predictive Value of Tests; Registries; Rehabilitation; Secondary prevention; Sweden - epidemiology; Time Factors; Treatment Outcome
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-024-02425-6

Despite the detrimental impact of abnormal glucose metabolism on cardiovascular prognosis after myocardial infarction (MI), diabetes is both underdiagnosed and undertreated. We investigated associations between structured diabetes care routines in cardiac rehabilitation (CR) and detection and treatment of diabetes at one-year post-MI. Center-level data was derived from the Perfect-CR survey, which evaluated work routines applied at Swedish CR centers (n = 76). Work routines involving diabetes care included: (1) routine assessment of fasting glucose and/or HbA1c, (2) routine use of oral glucose tolerance test (OGTT), (3) having regular case rounds with diabetologists, and (4) whether glucose-lowering medication was adjusted by CR physicians. Patient-level data was obtained from the national MI registry SWEDEHEART (n = 7601, 76% male, mean age 62.6 years) and included all post-MI patients irrespective of diabetes diagnosis. Using mixed-effects regression we estimated differences between patients exposed versus. not exposed to the four above-mentioned diabetes care routines. Outcomes were newly detected diabetes and the proportion of patients receiving oral glucose-lowering medication at one-year post-MI. Routine assessment of fasting glucose/HbA1c was performed at 63.2% (n = 48) of the centers, while 38.2% (n = 29) reported using OGTT for detecting glucose abnormalities. Glucose-lowering medication adjusted by CR physicians (n = 13, 17.1%) or regular case rounds with diabetologists (n = 7, 9.2%) were less frequently reported. In total, 4.0% of all patients (n = 304) were diagnosed with diabetes during follow-up and 17.9% (n = 1361) were on oral glucose-lowering treatment one-year post-MI. Routine use of OGTT was associated with a higher rate of newly detected diabetes at one-year (risk ratio [95% confidence interval]: 1.62 [1.26, 1.98], p = 0.0007). At one-year a higher proportion of patients were receiving oral glucose-lowering medication at centers using OGTT (1.22 [1.07, 1.37], p = 0.0046) and where such medication was adjusted by CR physicians (1.31 [1.06, 1.56], p = 0.0155). Compared to having none of the structured diabetes care routines, the more routines implemented the higher the rate of newly detected diabetes (from 0 routines: 2.7% to 4 routines: 6.3%; p for trend = 0.0014). Having structured routines for diabetes care implemented within CR can improve detection and treatment of diabetes post-MI. A cluster-randomized trial is warranted to ascertai