The Effect Of Intensive Glycemic Control On Outcomes In Diabetic Patients Admitted With Decompensated Heart Failure

Background Optimal glycemic targets in patients with diabetes mellitus (DM) and congestive heart failure (HF) remain unclear. Amongst diabetic patients with HF, there is a suggestion that modest glycemic control has been associated with lower cardiovascular mortality. Little data exists to elucidate glucose lowering strategies in a similar hospitalized cohort of patients. This study aims to retrospectively analyze the impact of various levels of glucose lowering therapies on cardiovascular outcomes in patients admitted with decompensated HF. Methods In this retrospective analysis, a review was performed of patients admitted to Robert Wood Johnson University Hospital from January 1st, 2015 to January 1st, 2020 with concurrent admitting diagnoses of DM and HF. Outcomes data was acquired from chart review. A two-sample independent samples t-test was utilized to assess differences in outcomes including myocardial infarction (MI), renal replacement therapies (RRT), cerebrovascular accident (CVA), and mortality between groups with differing intensities of glycemic control. Results 250 patients were included in this analysis. Mean age was 74.2 ±14.2 years with 47.2% of female patients included in the study sample. The rates of prior coronary artery disease and hypertension were 47.6% and 56.8%, respectively. Mean left ventricular ejection fraction was 44.3 ±17.1%. The mean glucose level across all patients was 136.7 ±42.3 mg/dL. Patients with at least one documented blood glucose (BG) below 100 mg/dL sustained higher rates of myocardial infarction (46% versus 16%, p<0.001), need for renal replacement therapies (20% versus 6%, p=0.010) and mortality (34% versus 6%, p<0.001) relative to those that remained above 100 mg/dL (see Figure 1). Mortality differed amongst subgroups stratified by mean glucose values (75-100 mg/dL, 101-125 mg/dL, 126-150 mg/dL and >150 mg/dL, p=0.010 by ANOVA). Highest mortality was seen in the subgroup with mean BG 126-150 mg/dL. Conclusions In this single-center restrospective study, episodes of relative hypoglycemia (BG <100 mg/dL) in admitted patients with a history of DM and HF was associated with poor outcomes including an increased incidence of myocardial infarction, need for renal replacement therapies and mortality. This association should be further investigated with larger randomized clinical trials to identify optimal glucose control strategies amongst hospitalized patients with heart failure. Optimal glycemic targets in patients with diabetes mellitus (DM) and congestive heart failure (HF) remain unclear. Amongst diabetic patients with HF, there is a suggestion that modest glycemic control has been associated with lower cardiovascular mortality. Little data exists to elucidate glucose lowering strategies in a similar hospitalized cohort of patients. This study aims to retrospectively analyze the impact of various levels of glucose lowering therapies on cardiovascular outcomes in patients admitted with decompensated HF. In this retrospective analysis, a review was performed of patients admitted to Robert Wood Johnson University Hospital from January 1st, 2015 to January 1st, 2020 with concurrent admitting diagnoses of DM and HF. Outcomes data was acquired from chart review. A two-sample independent samples t-test was utilized to assess differences in outcomes including myocardial infarction (MI), renal replacement therapies (RRT), cerebrovascular accident (CVA), and mortality between groups with differing intensities of glycemic control. 250 patients were included in this analysis. Mean age was 74.2 ±14.2 years with 47.2% of female patients included in the study sample. The rates of prior coronary artery disease and hypertension were 47.6% and 56.8%, respectively. Mean left ventricular ejection fraction was 44.3 ±17.1%. The mean glucose level across all patients was 136.7 ±42.3 mg/dL. Patients with at least one documented blood glucose (BG) below 100 mg/dL sustained higher rates of myocardial infarction (46% versus 16%, p<0.001), need for renal replacement therapies (20% versus 6%, p=0.010) and mortality (34% versus 6%, p<0.001) relative to those that remained above 100 mg/dL (see Figure 1). Mortality differed amongst subgroups stratified by mean glucose values (75-100 mg/dL, 101-125 mg/dL, 126-150 mg/dL and >150 mg/dL, p=0.010 by ANOVA). Highest mortality was seen in the subgroup with mean BG 126-150 mg/dL. In this single-center restrospective study, episodes of relative hypoglycemia (BG <100 mg/dL) in admitted patients with a history of DM and HF was associated with poor outcomes including an increased incidence of myocardial infarction, need for renal replacement therapies and mortality. This association should be further investigated with larger randomized clinical trials to identify optimal glucose control strategies amongst hospitalized patients with heart failure.