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Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study
Vestre Viken Hlth Trust, Norway;Univ Oslo, Norway.
Vestfold Hosp Trust, Norway;Univ Oslo, Norway.
Vestfold Hosp Trust, Norway.
Univ Oslo, Norway.
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2018 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, article id 160Article in journal (Refereed) Published
Abstract [en]

Background: Understanding the determinants associated with prediabetes and type 2 diabetes in coronary patients may help to individualize treatment and modelling interventions. We sought to identify sociodemographic, medical and psychosocial factors associated with normal blood glucose (HbA1c < 5.7%), prediabetes (HbA1c 5.7-6.4%), and type 2 diabetes. Methods: A cross-sectional explorative study applied regression analyses to investigate the factors associated with glycaemic status and control (HbA1c level) in 1083 patients with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records at the index event and from a self-report questionnaire and clinical examination with blood samples at 2-36 months follow-up. Results: In all, 23% had type 2 diabetes, 44% had prediabetes, and 33% had normal blood glucose at follow-up. In adjusted analyses, type 2 diabetes was associated with larger waist circumference (Odds Ratio 1.03 per 1.0 cm, p = 0.001), hypertension (Odds Ratio 2.7, p < 0.001), lower high-density lipoprotein cholesterol (Odds Ratio 0.3 per1.0 mmol/L, p = 0. 002) and insomnia (Odds Ratio 2.0, p= 0.002). In adjusted analyses, prediabetes was associated with smoking (Odds Ratio 33, p = 0.001), hypertension (Odds Ratio 1.5, p = 0.03), and non-participation in cardiac rehabilitation (Odds Ratio 1.7, p = 0. 003). In patients with type 2 diabetes, a higher HbA(1c) level was associated with ethnic minority background (standardized beta [beta] 0.19, p = 0.005) and low drug adherence (0 0.17, p = 0.01). In patients with prediabetes or normal blood glucose, a higher HbA(1c) was associated with larger waist circumference (beta 0.13, p < 0.001), smoking (beta 0.18, p < 0.001), hypertension (beta 0.08, p = 0.04), older age (beta 0.16, p < 0.001), and non-participation in cardiac rehabilitation (beta 0.11, p = 0.005). Conclusions: Along with obesity and hypertension, insomnia and low drug adherence were the major modifiable factors associated with type 2 diabetes, whereas smoking and non-participation in cardiac rehabilitation were the factors associated with prediabetes. Further research on the effect of individual tailoring, addressing the reported significant predictors of failure, is needed to improve glycaemic control.

Place, publisher, year, edition, pages
BioMed Central, 2018. Vol. 18, article id 160
Keywords [en]
Secondary prevention, Coronary heart disease, Type 2 diabetes, Prediabetes, HbA(1c), Risk factor control, Glycaemic control, Psychosocial factors
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-77377DOI: 10.1186/s12872-018-0896-zISI: 000440660400001PubMedID: 30075751Scopus ID: 2-s2.0-85051086367OAI: oai:DiVA.org:lnu-77377DiVA, id: diva2:1243296
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2019-08-29Bibliographically approved

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Perk, Joep

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