The Utility of Screening for Pre-Diabetes and Diabetes Mellitus with Hba1c in Patients who are Admitted to the Hospital with Low or Intermediate Risk Chest Pain for Rule Out Myocardial Infraction

Abstract

Introduction: Diabetes is considered a coronary artery disease equivalent. With its ever-increasing prevalence, early detection and management are imperative. Glycosylated Hemoglobin (HbA1c) has become the recognized marker for screening and diagnosis of diabetes. Objective: To screen and diagnose patients for prediabetes and Diabetes Mellitus (DM), among patients admitted to the hospital with the principal diagnosis of low or intermediate risk chest pain to Rule Out Myocardial Infarction (ROMI). The study was done to emphasize the importance of diabetes screening in these patients and to include this test as part of a chest pain admission order set in our hospital. Methods: After randomized retrospective review of 400 patients, 175 subjects with no prior diagnosis of diabetes were included. Data variables included patient demographics, Body Mass Index (BMI), TIMI® score and HbA1c results when available. BMI and HbA1c were also analyzed to previously established categories. BMI (kg/m2) was categorized as 18 to 24.9, 25 to 29.9 and 30 and above as healthy (0), overweight (1) and obese (2), respectively. HbA1c was categorized as 6.1% (normal), 6.2 to 6.4% (Impaired Glycemic Control) and 6.5% and above as DM as per our hospital criterion. Data were then summarized using descriptive statistics; chi-square and analysis of variance were performed to determine relationships between the variables. Results: Of the 175 subjects, 18 had HbA1c greater than 6.5% (10%), 19 subjects (11%) had HbA1c greater than 6.2% (prediabetes) and 138 (79%) had HbA1c less than 6.1%. An analysis of variance comparing mean age, BMI and TIMI score by HbA1c categories revealed p-values of 0.894, 0.054 and 0.320, respectively. Conclusion: Patients who are admitted to the hospital for low/intermediate chest pain to rule out myocardial infarction should be screened for DM using HbA1c, as we identified 18 subjects (10%) with HbA1c greater than 6.5% and 19 subjects (11%) with prediabetes as a subset of the population. We suggest that the admission order set for "Chest Pain" include HbA1c to regularly screen patients for diabetes and prediabetes and recommend close follow-up of the patients who have prediabetes with repeat HbA1c. Strong consideration should be made in screening patients with elevated BMI >30 for DM if they are admitted not just for chest pain but also for other medical ailments.