MON-294 - Impact of Diabetes Subtype on in-Hospital Outcomes after Acute Myocardial Infarction

Background:
Diabetes mellitus is highly prevalent among patients hospitalized with acute myocardial infarction (AMI) and is associated with increased morbidity and mortality. Diabetes represents a heterogeneous disease spectrum with distinct pathophysiology across subtypes; however, contemporary U.S. data directly comparing in-hospital AMI outcomes between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) following AMI remain limited. We examined subtype-specific in-hospital outcomes following AMI using a nationally representative database.

Methods:
We conducted a retrospective cohort study using the 2022 National Inpatient Sample, identifying adult hospitalizations with a primary diagnosis of AMI. Patients were categorized as having no diabetes, T1DM, or T2DM based on ICD-10-CM codes. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, acute kidney injury (AKI), mechanical ventilation, length of stay (LOS), and hospitalization cost. Survey-weighted analyses generated national estimates. Multivariable logistic regression adjusted for demographics, comorbidities, payer status, income quartile, and hospital characteristics, and baseline chronic kidney disease identified using ICD-10-CM codes (N18.*), with results reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results:
Among an estimated 573,715 AMI hospitalizations nationwide, 58.7% occurred in patients without diabetes, 0.98% in patients with T1DM, and 40.3% in patients with T2DM. Unadjusted in-hospital mortality was highest in T1DM (6.5%), followed by T2DM (5.1%) and no diabetes (4.6%). After multivariable adjustment, T1DM remained associated with more than a twofold increase in in-hospital mortality compared with no diabetes (aOR 2.03, 95% CI 1.58–2.61), whereas T2DM was associated with a modest increase in risk (aOR 1.09, 95% CI 1.03–1.16). T1DM was also associated with increased odds of cardiogenic shock (aOR 1.80, 95% CI 1.48–2.18) and AKI (aOR 2.1, 95% CI 3.01–3.94). T2DM was likewise associated with higher odds of shock (aOR 1.10, 95% CI 1.04–1.15) and AKI (aOR 1.68, 95% CI 1.62–1.73). Mean LOS was longest in T1DM (5.9 days), followed by T2DM (5.1 days) and no diabetes (4.0 days).

Conclusions:
Diabetes was independently associated with worse in-hospital outcomes following AMI, with substantially higher risk among patients with T1DM compared with T2DM or no diabetes. These findings highlight clinically meaningful heterogeneity in cardiometabolic risk by diabetes subtype, with patients with T1DM representing a particularly high-risk population following AMI. Enhanced inpatient risk stratification and targeted management strategies may be warranted to improve outcomes in this group.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*