Key result
Only two of six completed randomized trials reported that insulin therapy significantly reduces mortality in acute coronary syndrome patients with hyperglycemia, highlighting a lack of robust evidence.
Why the study?
Does insulin infusion or glucose-potassium-insulin infusion reduce mortality and morbidity in patients with acute coronary syndrome and hyperglycaemia?
Systematic Review
Does insulin infusion or glucose-potassium-insulin infusion reduce mortality and morbidity in patients with acute coronary syndrome and hyperglycaemia?
There is currently a lack of robust evidence to support routine insulin infusion for managing hyperglycemia in acute coronary syndrome, with only two of six trials showing a mortality benefit.
Evidence does not support routine insulin in hyperglycemic ACS; leaves open mortality benefit and requires larger RCTs.
To review the management of blood glucose in acute coronary syndrome (ACS) a literature search was undertaken using Medline and Embase databases (January 1950—July 2008), bibliographies of retrieved articles, review articles and Department of Health reports. Trials were eligible for inclusion in the review if they (i) included patients with ACS and hyperglycaemia with or without diabetes or compared insulin infusion or glucose-potassium-insulin infusion with active controls, (ii) were randomised, and (iii) assessed mortality and morbidity. Eight trials met the above criteria (two of which have yet to report). Only two of the remaining six trials reported that insulin therapy significantly reduces mortality in ACS patients with hyperglycaemia. In conclusion ACS is of major public health importance in the UK and hyperglycaemia in the setting of ACS is associated with worse outcome. Current variability in management of blood glucose in ACS reflects a paucity of robust evidence to guide practice. Two ongoing trials may resolve the uncertainty about optimum blood glucose management in ACS.
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Devine et al. (2010) conducted a systematic review in Acute coronary syndrome and hyperglycaemia. Insulin infusion or glucose-potassium-insulin infusion vs. Active controls was evaluated on Mortality and morbidity. Only two of six completed randomized trials reported that insulin therapy significantly reduces mortality in acute coronary syndrome patients with hyperglycemia, highlighting a lack of robust evidence.
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