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PERI-ACUTE CORONARY SYNDROME GLYCEMIC CONTROL

PERI-ACUTE CORONARY SYNDROME GLYCEMIC CONTROL. 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. INTRODUCTION. Patients with diabetes have greater short- and long-term mortality after myocardial infarction (MI) than patients without diabetes.

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PERI-ACUTE CORONARY SYNDROME GLYCEMIC CONTROL

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  1. PERI-ACUTE CORONARY SYNDROME GLYCEMIC CONTROL 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

  2. INTRODUCTION • Patients with diabetes have greater short- and long-term mortality after myocardial infarction (MI) than patients without diabetes. • Patients without previously known diabetes, but presenting with hyperglycemia, and an acute MI have higher mortality than those without hyperglycemia. • Biochemical abnormalities associated with relative (or absolute) insulin deficiency may be harmful during the acute phase of an MI.

  3. DIGAMI • Insulin therapy in patients with diabetes presenting with an acute MI has been shown to be beneficial. The Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study used an insulin-glucose infusion to maintain blood glucose between 7.0 and 10.0 mmol/L for at least 24 hours and then multidose subcutaneous insulin therapy for at least 3 months. • One life was saved for every 9 patients treated. Particular benefit was seen in patients who had fewer cardiac risk factors and those who were not on insulin prior to randomization.

  4. FOLLOW UP • Use of an insulin-glucose infusion to improve glycemic control in the acute setting may be beneficial for all patients with diabetes presenting with an acute coronary syndrome (ACS). • Patients who are treated with a multidose insulin regimen after an MI should be followed closely by a diabetes healthcare team with experience in managing intensified insulin therapy in order to maintain optimal glycemic control safely.

  5. PERI-ACS GLYCEMIC CONTROL- RECOMMENDATION • All patients with acute MI, regardless of whether or not they have a prior diagnosis of diabetes, should have their BG level measured on admission [Grade D, Consensus] and those with BG >12.0 mmol/L should receive insulin-glucose infusion therapy to maintain BG between 7.0 and 10.0 mmol/L for at least 24 hours, followed by multidose SC insulin for at least 3 months [Grade A, Level 1A]. An appropriate protocol should be developed and staff trained to ensure the safe and effective implementation of this therapy and to minimize the likelihood of hypoglycemia [Grade D, Consensus].

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