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Blood glucose control for patients with acute coronary syndromes in Qatar
Kyle John Wilby1, Eman Elmekaty1, Ibtihal Abdallah1
1College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar.
Insights
High blood glucose in acute coronary syndrome (ACS) patients is common. Diabetes is a key predictor of elevated glucose on admission, indicating inadequate glucose control in cardiac care units.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Medicine
Background:
- Elevated blood glucose is frequently observed in patients with acute coronary syndromes (ACS).
- Effective management strategies for hyperglycemia in acute care settings remain unclear.
- Predictive factors for elevated glucose upon initial presentation are not well-established.
Purpose of the Study:
- To characterize blood glucose control in patients admitted to the cardiac care unit (CCU) in Qatar.
- To identify factors predicting high glucose levels (>10 mmol/l) on CCU admission.
Main Methods:
- Retrospective chart review of 283 patients admitted to a CCU in Qatar (October 2012 - March 2013).
- Analysis of baseline characteristics, blood glucose measurements (capillary and lab), and insulin use.
- Logistic regression to assess predictors of high admission glucose, using both capillary and laboratory data.
Main Results:
- The majority of time spent by patients was in the hyperglycemic range (>10 mmol/l, 41.95%).
- Diabetes, hypertension, and non-smoker status were univariate predictors of high admission glucose.
- Only diabetes remained a significant predictor (OR 23.3) in the multivariate analysis.
Conclusions:
- Diabetes is a significant predictor of elevated blood glucose on hospital admission for ACS patients.
- Current glucose control within the CCU appears inadequate for many patients.
Background:
Blood glucose is known to be elevated in patients presenting with acute coronary syndromes. However a gap in knowledge exists regarding effective management strategies once admitted to acute care units. It is also unknown what factors (if any) predict elevated glucose values during initial presentation.
Objectives:
OBJECTIVES of the study were to characterize blood glucose control in patients admitted to the cardiac care unit (CCU) in Qatar and to determine predictive factors associated with high glucose levels (>10 mmol/l) on admission to the CCU.
Setting:
All data for this study were obtained from the CCU at Heart Hospital in Doha, Qatar.
Method:
A retrospective chart review was completed for patients admitted to the CCU in Qatar from October 1st, 2012 to March 31st, 2013, of which 283 were included. Baseline characteristics (age, gender, nationality, medical history, smoking status, type of acute coronary syndrome), capillary and lab blood glucose measurements, and use of insulin were extracted. Time spent in glucose ranges of <4, 4 to <8, 8 to <10, and >10 mmol/1 was calculated manually. Univariate and multivariate logistic regression were performed to assess factors associated with high glucose on admission. The primary analysis was completed with capillary data and a sensitivity analysis was completed using laboratory data.
Main Outcome Measure:
Blood glucose values measured on admission and throughout length of stay in the CCU.
Results:
Capillary blood glucose data showed majority of time was spent in the range of >10 mmol/l (41.95%), followed by 4-8 mmol/l (35.44%), then 8-10 mmol/l (21.45%), and finally <4 mmol/l (1.16%). As a sensitivity analysis, laboratory data showed very similar findings. Diabetes, hypertension, and non-smoker status predicted glucose values >10 mmol/l on admission (p < 0.05) in a univariate analysis but only diabetes remained significant in a multivariate model (OR 23.3; 95% CI, 11.5-47.3).
Conclusion:
Diabetes predicts high glucose values on hospital admission for patients with ACS and patients are not being adequately controlled throughout CCU stay.
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