2276-P: Reexamining the Diabetes Paradox: A National Analysis of Hyperglycemia across Acute Cardiovascular and Pulmonary Hospitalizations, 2016–2023

Introduction and Objective: Diabetes mellitus (DM) has been associated with lower inpatient mortality in several acute medical conditions, a counterintuitive finding commonly described as the “diabetes paradox.” Patients with DM often have acute hyperglycemia. Exploring if patients with hyperglycemia have lower inpatient mortality independent of DM may help explain the paradox. Methods: A retrospective, survey-weighted analysis of the National Inpatient Sample (NIS) from 2016-2023 was performed. Four cohorts were formed using ICD-10-CM codes from adult urban hospitalizations with a principal diagnosis of CHF, COPD, acute MI (AMI), or stroke. All cohorts had hyperglycemia without DM, identified by the R73* ICD-10-CM code. The primary outcome was in-hospital mortality. Survey-weighted logistic and linear regression models were used. These were adjusted for demographics, payer, socioeconomic status, hospital characteristics, calendar year, and APR-DRG severity where available. Results: The analysis represented >42 million weighted hospitalizations. Unweighted cohort sizes were CHF 281,589. COPD 566,162, AMI 913,060 and stroke 907,213. Hyperglycemia without DM was found in 2.0-2.6% of CHF, 4.7% of COPD, 4.9-5.7% of AMI, and 4.2-4.8% of stroke admissions. Hyperglycemia without DM had no significant impact on mortality in CHF (OR 0.82, 95% CI 0.53-1.26) or COPD admissions (OR 1.07, 95% CI 0.94-1.21). In AMI (OR 1.25, 95% CI 1.19-1.31) and stroke (OR 1.06, 95% CI 1.01-1.12) admissions, hyperglycemia without DM increased mortality. Conclusion: The DM paradox may reflect a yet unidentified impact of the overall metabolic syndrome, but hyperglycemia alone does not consistently confer any of the protective effects seen with DM. Further research may identify other components of the DM phenotype that are producing this effect. Disclosure J. Everett: None. P. Chaganlal: None. D.T. Jones: None. P. Shah: None.