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Myocardial infarction and type II diabetes--preferential treatment for high risk patients?
B Green1, S Duffull, N Cottrell
1Department of Pharmacy, Royal Brisbane Hospital, Brisbane, Queensland, Australia. greenb@pharmacy.uq.edu.au
Insights
Patients with type II diabetes and myocardial infarction (MI) exhibit greater blood glucose variability during initial hospital admission compared to those without MI. This highlights the need for standardized glucose management in diabetic patients with cardiovascular events.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Type II diabetes mellitus is a significant risk factor for cardiovascular disease.
- Myocardial infarction (MI) in diabetic patients often leads to complex clinical management challenges.
- Glycemic control is crucial in managing diabetic patients, especially those with acute cardiac events.
Purpose of the Study:
- To compare blood glucose variability in type II diabetic patients with and without myocardial infarction.
- To identify predictors of elevated blood glucose levels upon hospital discharge in this population.
Main Methods:
- A retrospective, matched case-control study design was employed.
- 101 type II diabetic patients with MI (cases) and 101 matched controls without MI were analyzed.
- Blood glucose concentrations were measured over two consecutive 48-hour periods; demographic data and treatment information were also collected.
Main Results:
- Diabetic patients with MI showed significantly greater blood glucose variability within the first 48 hours of admission compared to controls.
- Elevated discharge blood glucose (>8.2 mmol/L) in MI patients was associated with a lower likelihood of prior MI, ischemic heart disease, or hypertension.
- Patient characteristics were comparable at recruitment, except for family history of cardiovascular disease, dyslipidemia, and previous MI.
Conclusions:
- Type II diabetics experiencing MI demonstrate higher and more variable blood glucose levels during the initial 48 hours of hospitalization.
- Only patients identified as 'high risk' for cardiovascular events had target blood glucose levels set upon discharge.
- Further randomized controlled trials are warranted to evaluate the efficacy of standardized glucose infusions in reducing blood glucose variability in diabetic patients with MI.
Objectives:
To compare variability of blood glucose concentration in patients with type II diabetes with (cases) and without (controls) myocardial infarction. A secondary objective was identification of predictive factors for higher blood glucose on discharge from hospital.
Design:
A retrospective matched case-control study.
Participants:
Medical notes of 101 type II diabetic patients admitted with a myocardial infarction (MI) and 101 type II diabetic patients (controls) matched on gender and age with no MI were reviewed. Blood glucose concentrations over two consecutive 48-h periods were collected. Demographic data and therapy on admission/discharge were also collected.
Results:
Patient characteristics were comparable on recruitment excluding family history of cardiovascular disease (P=0.003), dyslipidaemia (P=0.004) and previous history of MI (P=0.007). Variability of blood glucose in cases was greater over the first 48 h compared with the second 48 h (P=0.03), and greater when compared with controls over the first 48 h (P=0.01). Cases with blood glucose on discharge >8.2 mmol / L (n=45) were less likely to have a history of previous MI (P=0.04), ischaemic heart disease (P=0.03) or hypertension (P=0.02).
Conclusions:
Type II diabetics with an MI have higher and more variable blood glucose concentrations during the first 48 h of admission. Only cardiovascular 'high risk' patients had target blood glucose set on discharge. The desirability of all MI patients with diabetes, having standardized-glucose infusions to reduce variability of blood glucose, should be evaluated in a randomized controlled trial.