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Glycaemic control in people with diabetes following acute myocardial infarction

Harriet Esdaile1, Neil Hill2, Jamil Mayet3

  • 1Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial Centre for Translational and Experimental Medicine, Imperial College London, Du Cane Road, London, W12 0NN, London, United Kingdom.

Diabetes Research and Clinical Practice
|March 30, 2023
PubMed

Insights

People with diabetes face higher risks after myocardial infarction due to complications like coronary atherosclerosis and diabetic cardiomyopathy. Further research is needed on optimal glycemic control and variability management post-heart attack.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Diabetes mellitus significantly increases cardiovascular morbidity and mortality, especially following acute myocardial infarction (MI).
  • Diabetic patients experience heightened risks post-MI due to factors including advanced coronary atherosclerosis, coronary microvascular dysfunction, and diabetic cardiomyopathy.
  • Persistent vascular inflammation and endothelial dysfunction, driven by dysglycemia, contribute to poor outcomes even with improved glycemic control.

Purpose of the Study:

  • To review the current understanding of complications and mortality risks in diabetic patients post-myocardial infarction.
  • To examine the role of glycemic control, including variability, in the peri-infarct and long-term periods following MI.
  • To explore emerging technologies and therapeutic strategies for managing diabetes after MI.

Main Methods:

  • Literature review of studies on diabetes, myocardial infarction, and cardiovascular outcomes.
  • Analysis of the impact of dysglycemia, endothelial dysfunction, and inflammation on post-MI prognosis.
  • Discussion of the potential of continuous glucose monitoring (CGM) and novel pharmacotherapies.

Main Results:

  • Despite advances in MI care, diabetic patients remain at elevated risk for complications and mortality.
  • Evidence for optimal glycemic control strategies beyond the peri-infarct period is limited, with no established consensus.
  • Glycemic variability is recognized as a significant factor influencing prognosis after MI.

Conclusions:

  • Diabetes confers a substantial risk of adverse outcomes after myocardial infarction, necessitating specialized management.
  • Further research is crucial to establish evidence-based guidelines for glycemic control and variability management in diabetic patients post-MI.
  • Continuous glucose monitoring and novel therapeutic agents offer promising avenues for improving outcomes in this high-risk population.

Keywords:
Continuous glucose monitoringDiabetes technologyIschaemic heart diseaseType 1 diabetesType 2 diabetes

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