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Treatment disparities in the care of patients with and without diabetes presenting with non-ST-segment elevation acute coronary syndromes.
Diabetes Care. 2006 Jan; 29(1):9-14.DC

Abstract

OBJECTIVE

The objective of this study was to characterize treatment patterns among patients with diabetes presenting with non-ST-segment elevation (NSTE) acute coronary syndromes (ACSs).

RESEARCH DESIGN AND METHODS

We compared adherence to treatment recommendations from the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for NSTE ACS among 46,410 patients from 413 U.S. hospitals that were included in the Can Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Patients were stratified as nondiabetic, non-insulin-dependent diabetic (type 2 diabetic), and insulin-treated diabetic.

RESULTS

Insulin-treated diabetic patients were less likely than nondiabetic patients to receive aspirin (adjusted odds ratio 0.83 [95% CI 0.74-0.93]), beta-blockers (0.89 [0.83-0.96]), heparin (0.90 [0.83-0.98]), and glycoprotein IIb/IIIa inhibitors (0.86 [0.79-0.93]). Type 2 diabetic patients were treated similarly to nondiabetic patients. After adjustment for differences in clinical characteristics, insulin-treated diabetic patients were significantly less likely than nondiabetic patients to receive cardiac catheterization within 48 h of presentation (0.80 [0.74-0.86]) or percutaneous coronary intervention (0.87 [0.82-0.94]). Compared with nondiabetic patients, insulin-treated diabetic and type 2 diabetic patients were more likely to undergo coronary artery bypass grafting (1.34 [1.21-1.49] and 1.35 [1.26-1.44]). In-hospital mortality rates were higher in insulin-treated diabetic (6.8%) and type 2 diabetic (5.4%) than in nondiabetic (4.4%) patients.

CONCLUSIONS

Diabetic patients have a higher risk of mortality than nondiabetic patients, yet physicians adhere to the ACC/AHA NSTE ACS guidelines less often when treating diabetic patients, particularly insulin-treated diabetic patients. Increased use of guideline-recommended therapies and early invasive management strategies in diabetic patients may improve their outcomes.

Authors+Show Affiliations

Department of Emergency Medicine, New York University School of Medicine/North Shore Long Island Jewish Health System, Plainview, New York 11803, USA. gbrogan@nshs.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

16373888

Citation

Brogan, Gerard X., et al. "Treatment Disparities in the Care of Patients With and Without Diabetes Presenting With non-ST-segment Elevation Acute Coronary Syndromes." Diabetes Care, vol. 29, no. 1, 2006, pp. 9-14.
Brogan GX, Peterson ED, Mulgund J, et al. Treatment disparities in the care of patients with and without diabetes presenting with non-ST-segment elevation acute coronary syndromes. Diabetes Care. 2006;29(1):9-14.
Brogan, G. X., Peterson, E. D., Mulgund, J., Bhatt, D. L., Ohman, E. M., Gibler, W. B., Pollack, C. V., Farkouh, M. E., & Roe, M. T. (2006). Treatment disparities in the care of patients with and without diabetes presenting with non-ST-segment elevation acute coronary syndromes. Diabetes Care, 29(1), 9-14.
Brogan GX, et al. Treatment Disparities in the Care of Patients With and Without Diabetes Presenting With non-ST-segment Elevation Acute Coronary Syndromes. Diabetes Care. 2006;29(1):9-14. PubMed PMID: 16373888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment disparities in the care of patients with and without diabetes presenting with non-ST-segment elevation acute coronary syndromes. AU - Brogan,Gerard X,Jr AU - Peterson,Eric D, AU - Mulgund,Jyotsna, AU - Bhatt,Deepak L, AU - Ohman,E Magnus, AU - Gibler,W Brian, AU - Pollack,Charles V,Jr AU - Farkouh,Michael E, AU - Roe,Matthew T, PY - 2005/12/24/pubmed PY - 2006/3/9/medline PY - 2005/12/24/entrez SP - 9 EP - 14 JF - Diabetes care JO - Diabetes Care VL - 29 IS - 1 N2 - OBJECTIVE: The objective of this study was to characterize treatment patterns among patients with diabetes presenting with non-ST-segment elevation (NSTE) acute coronary syndromes (ACSs). RESEARCH DESIGN AND METHODS: We compared adherence to treatment recommendations from the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for NSTE ACS among 46,410 patients from 413 U.S. hospitals that were included in the Can Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Patients were stratified as nondiabetic, non-insulin-dependent diabetic (type 2 diabetic), and insulin-treated diabetic. RESULTS: Insulin-treated diabetic patients were less likely than nondiabetic patients to receive aspirin (adjusted odds ratio 0.83 [95% CI 0.74-0.93]), beta-blockers (0.89 [0.83-0.96]), heparin (0.90 [0.83-0.98]), and glycoprotein IIb/IIIa inhibitors (0.86 [0.79-0.93]). Type 2 diabetic patients were treated similarly to nondiabetic patients. After adjustment for differences in clinical characteristics, insulin-treated diabetic patients were significantly less likely than nondiabetic patients to receive cardiac catheterization within 48 h of presentation (0.80 [0.74-0.86]) or percutaneous coronary intervention (0.87 [0.82-0.94]). Compared with nondiabetic patients, insulin-treated diabetic and type 2 diabetic patients were more likely to undergo coronary artery bypass grafting (1.34 [1.21-1.49] and 1.35 [1.26-1.44]). In-hospital mortality rates were higher in insulin-treated diabetic (6.8%) and type 2 diabetic (5.4%) than in nondiabetic (4.4%) patients. CONCLUSIONS: Diabetic patients have a higher risk of mortality than nondiabetic patients, yet physicians adhere to the ACC/AHA NSTE ACS guidelines less often when treating diabetic patients, particularly insulin-treated diabetic patients. Increased use of guideline-recommended therapies and early invasive management strategies in diabetic patients may improve their outcomes. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/16373888/Treatment_disparities_in_the_care_of_patients_with_and_without_diabetes_presenting_with_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=16373888 DB - PRIME DP - Unbound Medicine ER -