A protocol using three-times-daily subcutaneous insulin or glucose-insulin-potassium infusion achieved adequate glycemic control in 87% of patients compared to 60% with varied methods (P<0.001).
Cohort (n=139)
Does a protocol using scheduled subcutaneous insulin or glucose-insulin-potassium infusion improve glycemic control in diabetic patients with suspected acute myocardial infarction compared to varied ad hoc management?
Simple protocols using scheduled subcutaneous insulin or GIK infusions significantly improve glycemic control in diabetic patients with acute myocardial infarction compared to ad hoc management.
Absolute Event Rate: 87% vs 60%
p-value: p=<0.001
Blood glucose control in patients with diabetes after myocardial infarction is often poor, and this may contribute to increased mortality in the diabetic patient. A retrospective review of the records of 71 diabetic patients admitted with suspected myocardial infarction, and managed using a variety of methods, showed that adequate control (mean blood glucose less than 234 mg/dl; 13 mmol/L) was achieved in only 60%. Continuation of oral hypoglycemic agents and the use of irregular intermittent insulin in response to hyperglycemia were particularly associated with poor control. In a prospective study 68 consecutive patients were managed using regular subcutaneous insulin injections three times daily or a glucose-insulin-potassium intravenous infusion (in those with cardiogenic shock, severe hyperglycemia, or unable to eat). Control was adequate in 87% (P less than 0.001 versus retrospective group) and mean blood glucose concentration on days 1 and 2 were significantly lower than in the retrospective group (167 versus 232; 165 versus 236 mg/dl; both P less than 0.001). Simple protocols using three-times-daily subcutaneous insulin or glucose-insulin-potassium infusion provide a practical method for achieving good glycemic control in the diabetic patient with suspected acute myocardial infarction.
Husband et al. (1985) conducted a cohort in Diabetes after acute myocardial infarction (n=139). Regular subcutaneous insulin injections or glucose-insulin-potassium intravenous infusion vs. Variety of methods including oral hypoglycemic agents and irregular intermittent insulin was evaluated on Adequate glycemic control (mean blood glucose <234 mg/dl; 13 mmol/L) (p=<0.001). A protocol using three-times-daily subcutaneous insulin or glucose-insulin-potassium infusion achieved adequate glycemic control in 87% of patients compared to 60% with varied methods (P<0.001).
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