Characteristics, Management, and Outcomes of Diabetes Subtypes in Patients With Cardiogenic Shock

BACKGROUND: There is a gap in current research looking at differences between diabetes subtypes in the setting of cardiogenic shock (CS). OBJECTIVES: The authors sought to evaluate differences in characteristics, management, and outcomes between patients with no diabetes mellitus (DM), type 1 DM (T1DM), and type 2 DM (T2DM) admitted with CS. METHODS: The National Readmissions Database was utilized to identify patients between 2016 and 2021 with any discharge diagnosis of CS. The cohort was divided into 3 groups: CS without DM, CS with T1DM, and CS with T2DM. The primary outcomes were all-cause in-hospital mortality and 30-day readmissions. RESULTS: A total of 1,073,340 patients hospitalized with CS were identified during the study period, of which 644,768 (60.0%) had no DM, 10,423 (1.0%) had T1DM, and 418,149 (39.0%) had T2DM. Those with T1DM were more likely to present with CS due to acute myocardial infarction and undergo invasive evaluation with left heart catheterization compared to those with T2DM and no DM. In-hospital mortality was higher among those with T1DM (adjusted OR: 1.16; 95% CI: 1.09-1.24) and T2DM (adjusted OR: 1.08; 95% CI: 1.07-1.10) compared to those without DM, and both groups were more likely to be readmitted within 30 days. Among patients with CS from acute myocardial infarction, in-hospital mortality was similar between patients with T1DM and no DM, but higher in those with T2DM. CONCLUSIONS: Patients with DM, particularly T1DM, who present with CS represent a high-risk cohort with greater in-hospital mortality and higher readmission rates compared to patients without DM.