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Acute coronary syndromes – therapy of hyperglycaemia


Authors: J. Rybka
Authors‘ workplace: Krajská nemocnice T. Bati, Zlín ;  Diabetologické centrum IK IPVZ, WHO-CC
Published in: Kardiol Rev Int Med 2007, 9(2): 104-108
Category: Editorial

Overview

Hyperglycaemia is a significant risk factor for increased mortality and morbidity in patients with acute coronary disease. Hence the importance of timely diagnosis of glucose tolerance disorders in patients with acute coronary syndrome (ACS). As a result, correcting hyperglycaemia and achieving the best control of glucose metabolism by anti-diabetic, primarily insulin treatment, are important in critically ill patients with ACS. The therapy of diabetic patients during and after an acute cardiac event is demanding because the target values for effective treatment with strict glycaemia control are practically the same as those for normoglycaemia. Only frequent monitoring of glycaemia and systemic measures can help avoid the risk of hypoglycaemia. However, the unexpectedly good results in critically ill patients justify the above strategy. Effective therapeutic strategy must be both multidisciplinary and multifactorial.

Keywords:
acute coronary syndrome – acute myocardial infarction – diabetes mellitus – impaired glucose tolerance – hyperglycaemia

– insulin resistance – PAD therapy – hypoglycaemia


Sources

1.Staněk V et al. Ischemická choroba srdeční. In: Aschermann M et al (eds). Kardiologie. Praha: Galén 2004: 595-753.

2.Bergenstal RM. Effective Insulin Therapy. In: De Fronzo RA et al (eds). International Textbook of Diabetes mellitus. Chichester: John Wiley and Sons 2004: 995-1017.

3.Mazze RS. Staged Diabetes Management A Systematic Approach. Chichester: John Wiley and Sons 2004.

4.Kimmel B, Inzucchi SE. Oral Agents for Type 2 Diabetes: An Update. Clin Diabetes 2005; 23(2): 64-76.

5.Rybka J. Současnost a blízká budoucnost léčby perorálními antidiabetiky. ČLČ 2004; 137(5): 137-144.

6.Bartnik M, Ryden L et al. Glucose tolerance in patients with Acute Myocardial Infarction. Eur Heart J 2004; 25: 1990-1997.

7.Bartnik M, Ryden L, Ferrari R. Euro Heart Survey Investigators. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 2004; 25(21): 1880-1890.

8.Norhammar A, Tenerz A, Nilson G et al Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002; 359: 2140-2144.

9.Malmberg K, Norhammar A, Wedel H, Ryden L.Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation 1999; 99: 2626-2632.

10.Šimek S, Aschermann M, Holm F et al. Vliv přímé koronární angioplastiky na dlouhodobou prognózu nemocných s diabetem mellitem. Vnitř Lék 2004; 50: 118-125.

11.Malmberg K, Yusuf S, Gerstein HC et al. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischaemic Syndromes) Registry. Circulation 2000; 102: 1014-1019.

12.Malmberg K, Ryden L, Wedel H et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J 2005; 26(7): 650-661.

13.Danzig V, Šimek S, Šimková R. Ischemická choroba srdeční u diabetiků. Praha: Maxdorf 2006: 1-283.

14.Šimek S. Akutní koronární syndromy. In: Danzig V, Šimek S, Šimková R (eds). Ischemická choroba srdeční u diabetiků. Praha: Maxdorf 2006: 136-191.

15.ESC, EASD. Guidelines on Diabetes, pre-diabetes, and cardiovascular diseasaes: ESC and EASD Guidelines 2007: 1-72.

http://eurheartj.oxfordjournals.org/cgi/reprint/28/1/88

16.Van den Berghe G, Wouthers PJ, Weekers F et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359-1367.

17.Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004; 79: 992-1000.

18.Grey NJ, Perdrizet GA. Reduction of nosocomial infections in the surgical intensive-care unit strict glycaemic control. Endocr Pract 2004; 10(suppl 2): 46-52.

19.Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care 1999; 21: 69-78.

20.McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycaemia. Crit Care Clin 2001; 17: 107-124.

21.Hill M, McCallum R. Altered transcriptional regulation of phosphoenolpyruvate carboxykinase in rats following endotoxin treatment. J Clin Invest 1991; 88: 811-816.

22.Khani S, Tayek JA. Cortisol increases gluconeogenesis in humans: its role in the metabolic syndrome. Clin Sci (Lond) 2001; 101: 739-747.

23.Watt MJ, Howlett KF, Febbraio MA et al. Adrenalin increases skeletal muscle glycogenolysis, pyruvate dehydrogenase activation and carbohydrate oxidation during moderate exercise in humans. J Physiol 2001; 534: 269-278.

24.Flores EA, Istfan N, Pomposelli JJ et al. Effect of interleukin-1 and tumor necrosis factor/cachectin on glucose turnover in the rat. Metabolism 1990; 39: 738-743.

25.Sakurai Y, Zhang XJ, Wolfe RR. TNF directly stimulates glucose uptake and leucine oxidation and inhibits FFA flux in conscious dogs. Am J Physiol 119; 270: E864-E872.

26.Lang CH, Dobrescu C, Bagby GJ. Tumor necrosis factor impairs insulin action on peripheral glucose disposal and hepatic glucose output. Endocrinology 119; 130: 43-52.

27.Capes SE, Hunt D, Malmberg K et al. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 35: 773-778.

28.Muhlestein JB, Anderson JL, Horne BD et al. Effect of fasting glucose levels on mortality rate in patients with and without diabetes mellitus and coronary artery disease undergoing percutaneous coronary intervention. Am Heart J 2003; 146: 351-358.

29.Suematsu Y, Sato H, Ohtsuka T et al. Predictive risk factors for delayed extubation in patients undegoing coronary artery bypass grafting. Heart Vessels 2000; 15: 214-220.

30.Krinsley JS. Association between hyperglycaemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003; 78: 1471-1478.

31.Capes SE, Hunt D, Malmberg K et al. Stress hyperglycaemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001; 32: 2426-2432.

32.Yendamuri S, Fulda GJ, Tinkoff GH. Admission hyperglycaemia as a prognostic indicator in trauma. J Trauma 2003; 55: 33-38.

33.Laird AM, Miller PR, Kilgo PD et al. Relationship of early hyperglycaemia to mortality in trauma patients. J Trauma 2004; 56: 1058-1062.

34.Gore DC, Chinkes D, Heggers J et al. Association of hyperglycaemia with increased mortality after severe burn injury. J Trauma 2001; 51: 540-544.

35.Malmberg K, Norhammar A, Wedel H et al. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Study. Circulation 1999; 25: 2626-2632.

36.Malmberg K. Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 1997; 314: 1512-1515.

37.Malmberg K, Ryden L, Efendic S et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI) study: effects on mortality at 1 year. Am Coll Cardiol 1995; 26: 57-65.

38.Malmberg K, Ryden L, Wedel H et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J 2005; 26: 650-661.

39.Fath-Ordoubadi F, Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction: an overview of randomized placebo-controlled trials. Circulation 1997; 96: 1152-1156.

40.Diaz R, Paolasso EA, Piegas LS et al, on behalf of the ECLA Collaborative group. Metabolic modulation of acute myocardial infarction. The ECLA Glucose-Insulin-Potassium Pilot Trial. Circulation 1998; 98: 2227-2234.

41.Mehta SR, Yusuf S, Diaz R et al, CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled tria. The CREATE-ECLA Trial Group Investigators. JAMA 2005; 293: 437-446.

42.Wallner S, Watzinger N, Lindschinger M et al. Effects of intensified life style modification on the need for futher revascularization after coronary angioplasty. Eur J Clin Invest 1999; 29: 372-379.

43.Gaede P, Vedel P, Larsen N et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383-393.

44.UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 837-853.

45.Rybka J. Chronické koronární syndromy. In: Štejfa M et al (eds). Kardiologie. 3. ed. Praha: Grada 2007: 511-517.

46.Rybka J. Hospitalizovaný diabetik. In: Svačina Š (ed). Trendy soudobé diabetologie. Praha: Galén 2005: 119-167.

47.Van den Berghe G, Wilmer A, Hermans G et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006; 354: 449-461.

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Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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