It’s well-known among health-conscious people that heart disease and diabetes are linked, so it seems a shame to be hearing news from the American Heart Association that 10% of Americans who’ve had a heart attack probably have undiagnosed diabetes. What’s worse, though, is news that doctors are missing opportunities to detect and treat diabetes in people even when they are hospitalized for a heart attack.
Are so many doctors this clueless?
Although it might be a great challenge for health-care professionals to identify everyone with diabetes before complications, such as heart attack, occur, a basic precaution can at least help those who do land in the hospital because of heart attack. So if you’ve had a heart attack or have cardiovascular disease—or you want to be prepared to give yourself the best odds if you ever have a heart attack in the future—here’s what you need to insist that your medical-care team does for you, especially if you land in the hospital…
It comes down to getting a simple blood test. Doctors who order a hemoglobin A1c test when a patient is being treated for heart attack are making the right move to ensure that diabetes won’t be missed and the heart attack can be treated correctly, said Suzanne V. Arnold, MD, MHA, an assistant professor at the University of Missouri in Kansas City. She led a study on undiagnosed diabetes in heart attack patients that was reported at this year’s American Heart Association meeting. The hemoglobin A1c test shows average blood sugar levels for the preceding three months and is widely used to diagnose both type 1 and type 2 diabetes and monitor how well blood sugar is being controlled after diagnosis.
In her study, Dr. Arnold and her team took 2,854 patients who were hospitalized for heart attacks but had never received a diabetes diagnosis and arranged for them to have the hemoglobin A1c test. Both the hospitalized patients and the doctors treating them were kept in the dark (“blinded” in scientific speak) about the test results, and doctors were left to their business-as-usual patient care. Diabetes was considered “recognized” by the researchers if a patient either received diabetes education while hospitalized and/or diabetes medication when sent home.
The study results were a real eye-opener. Sure, Dr. Arnold’s team discovered that 10% of these patients had diabetes and didn’t know it, but the far bigger issue that patients and their families need to know about was that doctors failed to recognize diabetes in 69% of these previously undiagnosed patients.
That’s a major fail—especially when all it took for the treating doctors themselves to discover diabetes was to order the same simple, inexpensive A1c test that Dr. Arnold’s team had already ordered for their study.
Six months down the road, the researchers checked in on the patients they themselves knew had diabetes. They found that 71% of the patients whose diabetes had also been discovered by a doctor during their hospital stays were getting diabetes care. As for the patients whose diabetes had not been discovered by doctors treating them in the hospital, only 7% were getting diabetes care, meaning that the likelihood was strong that no one, except Dr. Arnold’s team, had yet checked these folks for diabetes. This left them at high risk for more cardiovascular complications, including additional heart attacks.
Knowing that a heart attack patient has type 2 diabetes is important in the moment because it determines treatment decisions, explained Dr. Arnold. For example, patients with multivessel coronary artery disease and diabetes may do better with bypass surgery (rather than stents) and particular blood pressure medications, such as ACE inhibitors.
Dr. Arnold’s advice for people who have heart attacks and survive…but don’t know whether they have diabetes…is that they insist on having a hemoglobin A1C test during their hospitalization. She does not advocate routine hemoglobin A1C screening for everyone, though, calling it “impractical,” although it’s certainly something you can bring up with your doctor if you know you have heart disease. And although you may be in-the-know about diabetes and heart disease prevention, this seems like a good place to include a refresher for you or a loved one. You can assess your risks and the warning signs of diabetes with these checklists from the American Diabetes Association:
Your chances of diabetes increase if you…
These are warning signs of diabetes…
It’s not very challenging for health-conscious people to avoid type 2 diabetes and heart disease, but keeping this bit of information on a simple blood test in mind can protect you or a loved one even more.
