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Published on: March 15, 2022
Periprocedural glycemic control in patients with diabetes mellitus undergoing coronary angiography with possible
Binita Shah1, Jeffrey S Berger2, Nicholas S Amoroso1
1Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
Insights
Continuing long-acting glucose-lowering medications before percutaneous coronary intervention (PCI) improves glycemic control and appears safe for patients with diabetes mellitus. This strategy helps achieve better blood glucose levels during the procedure.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Periprocedural hyperglycemia is a significant risk factor for mortality in patients undergoing percutaneous coronary intervention (PCI).
- Current management of blood glucose levels before PCI is not standardized, leading to variable patient outcomes.
- The impact of continuing long-acting glucose-lowering medications on glycemic control during PCI has not been previously investigated.
Purpose of the Study:
- To investigate the effects of routinely continuing versus holding long-acting glucose-lowering medications before coronary angiography with possible PCI on periprocedural glycemic control.
- To assess the safety and efficacy of this medication management strategy in patients with diabetes mellitus (DM).
Main Methods:
- A randomized controlled trial involving 172 patients with DM, allocated to either continue or hold their long-acting glucose-lowering medications before the procedure.
- Primary endpoint: glucose level at the time of procedural access.
- Secondary assessment in a subset of patients: platelet activity markers (leukocyte platelet aggregates, monocyte platelet aggregates, soluble p-selectin).
Main Results:
- Patients continuing their medications showed significantly lower blood glucose levels at procedural access (117 mg/dl) compared to those holding them (134 mg/dl) (p=0.002).
- Two instances of hypoglycemia occurred in the 'Continue' group, with no adverse events reported in either group.
- Significant differences in platelet activity markers were observed across groups, suggesting potential modulation of platelet function.
Conclusions:
- Routinely continuing prescribed long-acting glucose-lowering medications before PCI is an effective strategy for achieving periprocedural euglycemia.
- This approach appears safe and should be considered for optimizing glycemic control in patients undergoing PCI.
- The findings support a proactive medication management strategy to mitigate risks associated with periprocedural hyperglycemia.
Abstract:
Periprocedural hyperglycemia is an independent predictor of mortality in patients who underwent percutaneous coronary intervention (PCI). However, periprocedural management of blood glucose is not standardized. The effects of routinely continuing long-acting glucose-lowering medications before coronary angiography with possible PCI on periprocedural glycemic control have not been investigated. Patients with diabetes mellitus (DM; n = 172) were randomized to continue (Continue group; n = 86) or hold (Hold group; n = 86) their clinically prescribed long-acting glucose-lowering medications before the procedure. The primary end point was glucose level on procedural access. In a subset of patients (no DM group: n = 25; Continue group: n = 25; and Hold group: n = 25), selected measures of platelet activity that change acutely were assessed. Patients with DM randomized to the Continue group had lower blood glucose levels on procedural access compared with those randomized to the Hold group (117 [97 to 151] vs 134 [117 to 172] mg/dl, p = 0.002). There were two hypoglycemic events in the Continue group and none in the Hold group, and no adverse events in either group. Selected markers of platelet activity differed across the no DM, Continue, and Hold groups (leukocyte platelet aggregates: 8.1% [7.2 to 10.4], 8.7% [6.9 to 11.4], 10.9% [8.6 to 14.7], p = 0.007; monocyte platelet aggregates: 14.0% [10.3 to 16.3], 20.8% [16.2 to 27.0], 22.5% [15.2 to 35.4], p <0.001; soluble p-selectin: 51.9 ng/ml [39.7 to 74.0], 59.1 ng/ml [46.8 to 73.2], 72.2 ng/ml [58.4 to 77.4], p = 0.014). In conclusion, routinely continuing clinically prescribed long-acting glucose-lowering medications before coronary angiography with possible PCI help achieve periprocedural euglycemia, appear safe, and should be considered as a strategy for achieving periprocedural glycemic control.
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