Insomnia and low drug adherence, along with obesity and hypertension, were found to be major modifiable risk factors for type 2 diabetes after a coronary event, according to a study published in BMC Cardiovascular Disorders.
The researchers of this study evaluated 1083 patients after a coronary event for sociodemographic, medical, and psychosocial data to analyze potential risk factors for prediabetes and type 2 diabetes. Glycemic status and glycemic control were used to categorize patients into patients with type 2 diabetes, prediabetes, and normal blood glucose levels. At baseline, demographic factors, cardiovascular history and treatment, and other medications were detailed. At follow-up time points (2 to 36 months), blood tests, clinical exams, and self-reported sociodemographic, medical, and psychosocial questionnaires were administered.
At baseline, 16% of the patients had a diagnosis of type 2 diabetes, and at follow-up (median 16 months), 22% had a diagnosis of type 2 diabetes. Factors significantly associated with type 2 diabetes were a larger waist circumference (P=.001), uncontrolled blood pressure (P=.001), lower high-density lipoprotein cholesterol (P=.002), insomnia (P=.002), and perceived future restrictions due to heart condition (P=.001). Factors significantly associated with prediabetes were older age (P <.001), smoking (P=.001), uncontrolled blood pressure (P=.03), and non-adherent cardiac rehabilitation (P=.003). Factors significantly associated with higher glycated hemoglobin (HbA1c) levels in type 2 diabetes were ethnic minority (P=.005) and low drug adherence (P=.01). Factors statistically significant with higher HbA1c levels in prediabetes or normal blood glucose levels were older age (P<.001), higher waist circumference (P<.001), smoking (P<.001), non-adherent cardiac rehabilitation (P=.005), and uncontrolled blood pressure (P=.037).
Future studies need to evaluate the patients at more than 1 time point to reduce measurement bias and perform repeated HbA1c tests for a more accurate diagnosis.
These results provide information applicable to clinicians by identifying potential risk factors for those patients who experienced a coronary event and are struggling with glucose metabolism. Obesity, hypertension, insomnia, and low drug adherence were modifiable risk factors associated with type 2 diabetes after a coronary event.
Munkhaugen J, Hjelmesæth J, Otterstad JE, et al. Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed – a cross sectional study. BMC Cardiovasc Disord. 2018; 18:160.