Abstract 12053: Poor Glycemic Control is Associated with Increased Risk of Rehospitalization for Cardiovascular Disease (CVD) at 30 days among Diabetic Women but Not among Diabetic Men

Abstract

BACKGROUND: The extent to which poor glycemic control is associated with clinical outcomes among hospitalized diabetics with CVD is not established. Our aim was to determine if glycemic control was associated with rehospitalization for CVD, and to evaluate potential interaction according to gender.

METHODS: This was a prospective analysis of patients with physician-documented diabetes (N=902, 39% female, 53% racial/ethnic minority, mean age 67 ±12 years) who participated in an NHLBI-sponsored clinical outcomes study of patients hospitalized with CVD. Standardized clinical information was collected by survey and electronic medical record. HbA1c was analyzed in the hospital lab; the admission value or the closest value within one year was used. Poor glycemic control was defined as HbA1c ≥7. Rehospitalization at 30 days was documented using a hospital-based clinical information system. Multivariate logistic regression was utilized to evaluate the independent association between HbA1c and rehospitalization, and interaction was evaluated using gender stratified models.

RESULTS: The overall readmission rate at 30 days was 13% (n=119) and 91% of readmissions were for CVD (n=108). HbA1c ≥ 7 vs <7 was associated with an increased risk of 30-day rehospitalization for CVD (OR 1.63, 95% CI 1.05-2.54); which remained significant (OR 1.69, 95% CI 1.04-2.73) after adjustment for demographics (age, gender, race/ethnicity, health insurance, caregiving) and comorbidities (myocardial infarction, heart failure, stroke, renal disease, chronic obstructive pulmonary disease, statin use on discharge, surgery admission). There was a significant interaction between HbA1c and gender for risk of rehospitalization for CVD (p=0.005); the association was significant in women (OR 7.10, 95% CI 2.05-24.63), but not in men (OR 0.99, 95% CI 0.57-1.73) in multivariate adjusted models.

CONCLUSIONS: The risk of CVD rehospitalization at 30 days was 7-fold higher among diabetic women with poor glycemic control vs HbA1c <7, and no association was observed among men. The data underscore the importance of appropriate diabetic management in women with CVD. Further research is needed to understand the etiology of gender differences in glycemic control and clinical outcomes.