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Updated: May 27, 2026
A Method for Manipulating Blood Glucose and Measuring Resulting Changes in Cognitive Accessibility of Target Stimuli
Published on: August 12, 2016
Piloting a novel algorithm for glucose control in the coronary care unit: the RECREATE (REsearching Coronary
Kara A Nerenberg1, Abhinav Goyal, Denis Xavier
1Population Health Research Institute McMaster University, Hamilton, Ontario, Canada. recreate@phri.ca
Insights
A new paper-based insulin algorithm effectively lowered glucose levels in patients with acute myocardial infarction (AMI). This feasible approach demonstrated safe glucose management without increasing symptomatic hypoglycemia or affecting clinical outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Elevated glucose levels post-acute myocardial infarction (AMI) are linked to increased mortality.
- Previous glucose control trials after AMI have yielded inconsistent results regarding glucose reduction and mortality benefits.
- A novel paper-based algorithm was developed to manage glucose levels in AMI patients.
Purpose of the Study:
- To assess the feasibility and safety of a paper-based glucose-lowering algorithm in patients with AMI.
- To compare the effectiveness of the algorithm-guided insulin therapy against standard glycemic approaches.
Main Methods:
- 287 participants with ST-segment elevation myocardial infarction (STEMI) and hyperglycemia (glucose ≥8.0 mmol/L) were randomized.
- Intervention group received intravenous insulin glulisine via algorithm, followed by subcutaneous insulin glargine for 30 days.
- Control group received standard glycemic management; outcomes assessed at 24 hours, 72 hours, and 90 days.
Main Results:
- The insulin algorithm group achieved significantly lower mean glucose levels at 24 hours (6.53 vs. 7.94 mmol/L).
- Glucose level differences were sustained at 72 hours and 30 days.
- Biochemical hypoglycemia occurred more frequently in the insulin group (22.7% vs. 4.4%), but symptomatic hypoglycemia and clinical outcomes did not differ.
Conclusions:
- A paper-based insulin algorithm targeting glucose 5.0-6.5 mmol/L is feasible for CCU implementation.
- Further cardiovascular outcomes trials are warranted to determine if this targeted glucose lowering improves patient outcomes.
Objective:
Elevated glucose levels are common after an acute myocardial infarction (AMI) and increase the risk of death. Prior trials of glucose control after AMI have been inconsistent in their ability to lower glucose levels and have reported mixed effects on mortality. We developed a paper-based glucose-lowering algorithm and assessed its feasibility and safety in the setting of AMI.
Research Design And Methods:
A total of 287 participants with an acute ST segment elevation myocardial infarction (STEMI) and a capillary glucose level ≥8.0 mmol/L were randomly allocated to glucose management with intravenous glulisine insulin using this algorithm in the coronary care unit (CCU), followed by once-daily subcutaneous insulin glargine for 30 days versus standard glycemic approaches. The primary outcome was a difference in mean glucose levels at 24 h. Participants were followed for clinical outcomes through 90 days.
Results:
At 24 h, the mean glucose level was 1.41 mmol/L (95% CI 0.69-2.13) lower in the insulin (6.53 vs. 7.94 mmol/L). Differences in glucose levels were maintained at 72 h and 30 days. A total of 22.7% of the insulin group versus 4.4% of the standard group had biochemical hypoglycemia (with neither signs nor symptoms) in the CCU because of lower glycemic goals. However, there were no differences in symptomatic hypoglycemia or clinical outcomes between the groups.
Conclusions:
A paper-based insulin algorithm targeting glucose levels of 5.0-6.5 mmol/L (90-117 mg/dL) can be feasibly implemented in the CCU. A cardiovascular outcomes trial using this approach can determine whether targeted glucose lowering improves patient outcomes.
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