Response to Comment on Shore et al. Association Between Hyperglycemia at Admission During Hospitalization for Acute Myocardial Infarction and Subsequent Diabetes: Insights From the Veterans Administration Cardiac Care Follow-up Clinical Study. Diabetes Care 2014;37:409–418

We thank Meloni et al. (1) for sharing their observations with us. As their study closely agrees with ours (2) in a different patient population, it reinforces the importance of identifying admission hyperglycemia as a possible marker of previously unrecognized or incident diabetes in patients with acute myocardial infarction (AMI). Prior studies have shown the high prevalence of undiagnosed diabetes in AMI patients (3), and in our study nearly two out of five diabetic patients were potentially unrecognized in a large, integrated health care system (2). Accordingly, our findings, supported by similar observations made by Meloni et al., highlight the possible use of admission hyperglycemia as a screening metric for diabetes in AMI patients. Future studies should examine the ideal diagnostic modality for diabetes in the setting of AMI as conventional measures such as fasting and random glucose measurements may be influenced by the resultant glycemic dysregulation (4). In particular, utility of HbA_1c needs to be evaluated as it is easy to perform compared with oral glucose tolerance tests and is relatively inexpensive. Additionally, as timely diagnosis of diabetes is vital for optimal management of AMI patients (5), strong consideration should be given to diabetic screening programs for patients with admission hyperglycemia during or shortly after AMI hospitalization. Future studies should evaluate the optimal timing and impact of such screening interventions.