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Pepe M, Addabbo F, Cecere A, Tritto R, Napoli G, Nestola PL, Cirillo P, Biondi-Zoccai G, Giordano S, Ciccone MM. Acute Hyperglycemia-Induced Injury in Myocardial Infarction. Int J Mol Sci 2024; 25:8504. [PMID: 39126075 PMCID: PMC11313474 DOI: 10.3390/ijms25158504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Acute hyperglycemia is a transient increase in plasma glucose level (PGL) frequently observed in patients with ST-elevation myocardial infarction (STEMI). The aim of this review is to clarify the molecular mechanisms whereby acute hyperglycemia impacts coronary flow and myocardial perfusion in patients with acute myocardial infarction (AMI) and to discuss the consequent clinical and prognostic implications. We conducted a comprehensive literature review on the molecular causes of myocardial damage driven by acute hyperglycemia in the context of AMI. The negative impact of high PGL on admission recognizes a multifactorial etiology involving endothelial function, oxidative stress, production of leukocyte adhesion molecules, platelet aggregation, and activation of the coagulation cascade. The current evidence suggests that all these pathophysiological mechanisms compromise myocardial perfusion as a whole and not only in the culprit coronary artery. Acute hyperglycemia on admission, regardless of whether or not in the context of a diabetes mellitus history, could be, thus, identified as a predictor of worse myocardial reperfusion and poorer prognosis in patients with AMI. In order to reduce hyperglycemia-related complications, it seems rational to pursue in these patients an adequate and quick control of PGL, despite the best pharmacological treatment for acute hyperglycemia still remaining a matter of debate.
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Affiliation(s)
- Martino Pepe
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
| | - Francesco Addabbo
- ASL Taranto, Local Health Authority of Taranto, Statistics and Epidemiology Unit, 74100 Taranto, Italy;
| | - Annagrazia Cecere
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy;
| | - Rocco Tritto
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
| | - Gianluigi Napoli
- Division of Cardiology, Villa Verde Clinic, 74121 Taranto, Italy;
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy;
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Maria Cecilia Hospital, GVM Care & Research, 48032 Cotignola, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Marco Matteo Ciccone
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
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Kanjee Z, Brown FM, Taxin ZH, Smetana GW. How Would You Treat This Inpatient With Type 2 Diabetes Mellitus? Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2024; 177:1106-1117. [PMID: 39133925 DOI: 10.7326/annals-24-01100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Management of hospitalized patients with type 2 diabetes mellitus (T2DM) presents unique challenges. Two recently released guidelines, one from the American Diabetes Association and the other from the Endocrine Society, provide useful recommendations and evidence review to inform the care of medical inpatients with T2DM. These guidelines mostly agree, although there are slight differences in their recommendations. In these rounds, 2 expert diabetologists discuss their approach to inpatient management of T2DM, specifically regarding inpatient glycemic goals on the medical ward, the use of noninsulin antihyperglycemic medications, and patient safety strategies for patients receiving long-acting insulin. They conclude with recommendations for Mr. D, a real patient with T2DM admitted with a recurrent foot infection.
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Affiliation(s)
- Zahir Kanjee
- Harvard Medical School, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.K.)
| | - Florence M Brown
- Harvard Medical School, Joslin and BIDMC Diabetes in Pregnancy Program, Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Boston, Massachusetts (F.M.B.)
| | - Zachary H Taxin
- Harvard Medical School, Inpatient Diabetes Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.H.T.)
| | - Gerald W Smetana
- Harvard Medical School, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S.)
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3
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Li K, Yang X, Li Y, Xu G, Ma Y. Relationship between stress hyperglycaemic ratio and incidence of in-hospital cardiac arrest in patients with acute coronary syndrome: a retrospective cohort study. Cardiovasc Diabetol 2024; 23:59. [PMID: 38336786 PMCID: PMC10858560 DOI: 10.1186/s12933-024-02128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The stress hyperglycaemic ratio (SHR), a new marker that reflects the true hyperglycaemic state of patients with acute coronary syndrome (ACS), is strongly associated with adverse clinical outcomes in these patients. Studies on the relationship between the SHR and in-hospital cardiac arrest (IHCA) incidence are limited. This study elucidated the relationship between the SHR and incidence of IHCA in patients with ACS. METHODS In total, 1,939 patients with ACS who underwent percutaneous coronary intervention (PCI) at the Affiliated Hospital of Zunyi Medical University were included. They were divided into three groups according to the SHR: group T1 (SHR ≤ 0.838, N = 646), group T2 (0.838< SHR ≤ 1.140, N = 646), and group T3 (SHR3 > 1.140, N = 647). The primary endpoint was IHCA incidence. RESULTS The overall IHCA incidence was 4.1% (N = 80). After adjusting for covariates, SHR was significantly associated with IHCA incidence in patients with ACS who underwent PCI (odds ratio [OR] = 2.6800; 95% confidence interval [CI] = 1.6200-4.4300; p<0.001), and compared with the T1 group, the T3 group had an increased IHCA risk (OR = 2.1800; 95% CI = 1.2100-3.9300; p = 0.0090). In subgroup analyses, after adjusting for covariates, patients with ST-segment elevation myocardial infarction (STEMI) (OR = 3.0700; 95% CI = 1.4100-6.6600; p = 0.0050) and non-STEMI (NSTEMI) (OR = 2.9900; 95% CI = 1.1000-8.1100; p = 0.0310) were at an increased IHCA risk. After adjusting for covariates, IHCA risk was higher in patients with diabetes mellitus (DM) (OR = 2.5900; 95% CI = 1.4200-4.7300; p = 0.0020) and those without DM (non-DM) (OR = 3.3000; 95% CI = 1.2700-8.5800; p = 0.0140); patients with DM in the T3 group had an increased IHCA risk compared with those in the T1 group (OR = 2.4200; 95% CI = 1.0800-5.4300; p = 0.0320). The restriction cubic spline (RCS) analyses revealed a dose-response relationship between IHCA incidence and SHR, with an increased IHCA risk when SHR was higher than 1.773. Adding SHR to the baseline risk model improved the predictive value of IHCA in patients with ACS treated with PCI (net reclassification improvement [NRI]: 0.0734 [0.0058-0.1409], p = 0.0332; integrated discrimination improvement [IDI]: 0.0218 [0.0063-0.0374], p = 0.0060). CONCLUSIONS In patients with ACS treated with PCI, the SHR was significantly associated with the incidence of IHCA. The SHR may be a useful predictor of the incidence of IHCA in patients with ACS. The addition of the SHR to the baseline risk model had an incremental effect on the predictive value of IHCA in patients with ACS treated with PCI.
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Affiliation(s)
- Kui Li
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China
| | - Xueyuan Yang
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China
| | - Yunhang Li
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China
| | - Guanxue Xu
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China.
| | - Yi Ma
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China.
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4
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Yang Z, Liu H, Lu D, Cao S, Xu F, Li C. Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy: a meta-analysis. World J Emerg Med 2024; 15:181-189. [PMID: 38855366 PMCID: PMC11153375 DOI: 10.5847/wjem.j.1920-8642.2024.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/20/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND This meta-analysis aimed to assess the efficacy of high-dose glucose-insulin-potassium (GIK) therapy on clinical outcomes in acute coronary syndrome (ACS) patients receiving reperfusion therapy. METHODS We searched the PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library databases from inception to April 26, 2022, for randomized controlled trials (RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy. The primary endpoint was major adverse cardiovascular events (MACEs). RESULTS Eleven RCTs with 884 patients were ultimately included. Compared with placebos, high-dose GIK markedly reduced MACEs (risk ratio [RR] 0.57, 95% confidence interval [95% CI]: 0.35 to 0.94, P=0.03) and the risk of heart failure (RR 0.48, 95% CI: 0.25 to 0.95, P=0.04) and improved the left ventricular ejection fraction (LVEF) (mean difference [MD] 2.12, 95% CI: 0.40 to 3.92, P=0.02) at 6 months. However, no difference was observed in all-cause mortality at 30 d or 1 year. Additionally, high-dose GIK was significantly associated with increased incidences of phlebitis (RR 4.78, 95% CI: 1.36 to 16.76, P=0.01), hyperglycemia (RR 9.06, 95% CI: 1.74 to 47.29, P=0.009) and hypoglycemia (RR 6.50, 95% CI: 1.28 to 33.01, P=0.02) but not reinfarction, hyperkalemia or secondary reperfusion. In terms of oxidative stress-lowering function, high-dose GIK markedly reduced superoxide dismutase (SOD) activity but not glutathione peroxidase (GSH-Px) or catalase (CAT) activity. CONCLUSION Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering efficacy in response to high-dose GIK. Moreover, with a higher incidence of complications such as phlebitis, hyperglycemia, and hypoglycemia. Furthermore, there were no observed survival benefits associated with high-dose GIK. More trials with long-term follow-up are still needed.
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Affiliation(s)
- Zeyu Yang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary- Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan 250012, China
- National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Huiruo Liu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary- Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan 250012, China
- National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Dazhou Lu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary- Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan 250012, China
- National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Shengchuan Cao
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary- Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan 250012, China
- National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary- Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan 250012, China
- National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Chuanbao Li
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary- Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan 250012, China
- National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan 250012, China
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5
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Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 210] [Impact Index Per Article: 210.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Liu S, Song C, Cui K, Bian X, Wang H, Fu R, Zhang R, Yuan S, Dou K. Prevalence and prognostic impact of stress-induced hyperglycemia in patients with acute type A aortic dissection. Diabetes Res Clin Pract 2023; 203:110815. [PMID: 37419392 DOI: 10.1016/j.diabres.2023.110815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
AIMS To explore the prevalence of stress-induced hyperglycemia (SIH) in acute type A aortic dissection (ATAAD) patients without diabetes, and its impact on short-term and long-term clinical outcomes. METHODS A total of 1098 patients with confirmed diagnosis of ATAAD were consecutively enrolled. According to the admission blood glucose (BG), patients were divided into the normoglycemia group (BG < 7.8 mmol/L), mild to moderate SIH group (7.8 ≤ BG < 11.1 mmol/L) and severe SIH group (BG ≥ 11.1 mmol/L). Multivariate regression analysis were used to explore the association between SIH and mortality risk. RESULTS There were 421 ATAAD patients (38.3%) with SIH, including 361 cases (32.9%) in the mild to moderate group and 60 cases (5.46%) in the severe group. The proportion of high-risk clinical manifestations and conservative treatment was greater in the SIH group than the normoglycemia group. Severe SIH was associated with high risk of 30-day (OR: 3.773, 95%CI: 1.004-14.189, P = 0.0494) and 1-year mortality risk (OR: 3.522 95%CI: 1.018-12.189, P = 0.0469). CONCLUSIONS Approximately 40% of the patients with ATAAD had SIH, and were more likely to present with high-risk clinical features and receive non-surgical treatment. Severe SIH could be used as an independent predictor of increased short-term and long-term mortality risk and reflect the disease severity of ATAAD.
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Affiliation(s)
- Shuai Liu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Chenxi Song
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Kongyong Cui
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Xiaohui Bian
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Hao Wang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Rui Fu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Rui Zhang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Sheng Yuan
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Kefei Dou
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China.
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Esdaile H, Hill N, Mayet J, Oliver N. Glycaemic control in people with diabetes following acute myocardial infarction. Diabetes Res Clin Pract 2023; 199:110644. [PMID: 36997029 DOI: 10.1016/j.diabres.2023.110644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
Diabetes is a highly prevalent disease associated with considerable cardiovascular end organ damage and mortality. Despite significant changes to the management of acute myocardial infarction over the last two decades, people with diabetes remain at risk of complications and mortality following a myocardial infarct for a multitude of reasons, including increased coronary atherosclerosis, associated coronary microvascular dysfunction, and diabetic cardiomyopathy. Dysglycaemia causes significant endothelial dysfunction and upregulation of inflammation within the vasculature and epigenetic changes mean that these deleterious effects may persist despite subsequent efforts to tighten glycaemic control. Whilst clinical guidelines advocate for the avoidance of both hyper- and hypoglcyaemia in the peri-infarct period, the evidence base is lacking, and currently there is no consensus on the benefits of glycaemic control beyond this period. Glycaemic variability contributes to the glycaemic milieu and may have prognostic importance following myocardial infarct. The use of continuous glucose monitoring means that glucose trends and parameters can now be captured and interrogated, and its use, along with newer medicines, may provide novel opportunities for intervention after myocardial infarction in people with diabetes.
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Affiliation(s)
- Harriet Esdaile
- Faculty 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.
| | - Neil Hill
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction Imperial College London, London, United Kingdom
| | - Jamil Mayet
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nick Oliver
- Faculty of Medicine, Department of Metabolism Digestion and Reproduction, Imperial College London, London, United Kingdom
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8
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Yuan Y, Tao J, Shen X, Cheng H, Dong X, Muyesai N, Wang Z, Li N. Elevated random glucose levels at admission are associated with all-cause mortality and cardiogenic shock during hospitalisation in patients with acute myocardial infarction and without diabetes: A retrospective cohort study. Diabetes Metab Res Rev 2023; 39:e3617. [PMID: 36729039 DOI: 10.1002/dmrr.3617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Elevated glucose levels at admission are associated with a worse prognosis in patients with acute myocardial infarction (AMI); additionally, such elevation has a higher prognostic value for patients without diabetes. METHODS We retrospectively recruited 2412 AMI patients without diabetes from 1 August 2011 to 10 January 2022. The primary outcome was all-cause mortality during hospitalisation, and the secondary outcomes were cardiogenic shock, ventricular tachycardia, ventricular fibrillation, atrioventricular block and new stroke. RESULTS The mean age of participants was 65 years and 78.6% were male. Of the 2412 patients, all-cause mortality occurred in 236 patients (9.8%) during hospitalisation. In multivariate-adjusted models that corrected for variable weights, the risk of all-cause mortality increased with an increase in random glucose levels at admission; specifically, the risk of all-cause mortality increased per 1 mg/dL (odds ratio [OR] 1.006, 95% confidence interval [CI]: 1.004-1.008), per 9 mg/dL (OR: 1.06, 95% CI: 1.04-1.08), and per 18 mg/dL (OR: 1.12, 95% CI: 1.07-1.16) increases in admission glucose levels. When admission glucose levels were expressed as a categorical variable, increased levels of glucose (relative to the reference glucose value <140 mg/dL) led to an increased risk of all-cause mortality; specifically, the OR of all-cause mortality for 140-200 mg/dL glucose was 1.55 (95% CI: 1.09-2.17) and the OR for glucose >200 mg/dL was 3.08 (95% CI: 2.00-4.62) (P for trend <0.001). The risk of cardiogenic shock also increased with glucose levels with an OR of 1.68 (95% CI: 1.21-2.31) for 140-200 mg/dL glucose and an OR of 3.72 (95% CI: 2.50-5.46) for >200 mg/dL, compared with that of glucose <140 mg/dL. In multivariate-adjusted spline regression models, an increased risk of all-cause mortality was observed in patients with glucose ≥122 mg/dL (OR: 1.81, 95% CI: 1.38-2.38, p < 0.001) compared with the reference cohort. Furthermore, patients with glucose ≥111 mg/dL (OR: 2.36, 95% CI: 1.80-3.12) had a higher risk of cardiogenic shock than patients with glucose <111 mg/dL. CONCLUSIONS Patients with AMI and without diabetes who had elevated random glucose levels at admission had a higher risk of all-cause mortality and cardiogenic shock during hospitalisation. In particular, patients with glucose ≥122 mg/dL had an increased risk of all-cause mortality, and those with glucose ≥111 mg/dL had an increased risk of cardiogenic shock.
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Affiliation(s)
- Yujuan Yuan
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Jing Tao
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Xin Shen
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Hui Cheng
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Xiangyu Dong
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Nijiati Muyesai
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Zhao Wang
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Nanfang Li
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
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9
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Krinsley JS, Rule P, Brownlee M, Roberts G, Preiser JC, Chaudry S, Dionne K, Heluey-Rodrigues C, Umpierrez GE, Hirsch IB. Acute and Chronic Glucose Control in Critically Ill Patients With Diabetes: The Impact of Prior Insulin Treatment. J Diabetes Sci Technol 2022; 16:1483-1495. [PMID: 34396800 PMCID: PMC9631540 DOI: 10.1177/19322968211032277] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emerging data highlight the interactions of preadmission glycemia, reflected by admission HbA1c levels, glycemic control during critical illness, and mortality. The association of preadmission insulin treatment with outcomes is unknown. METHODS This observational cohort study includes 5245 patients admitted to the medical-surgical intensive care unit of a university-affiliated teaching hospital. Three groups were analyzed: patients with diabetes with prior insulin treatment (DM-INS, n = 538); patients with diabetes with no prior insulin treatment (DM-No-INS, n = 986); no history of diabetes (NO-DM, n = 3721). Groups were stratified by HbA1c level: <6.5%; 6.5%-7.9% and >8.0%. RESULTS Among the three strata of HbA1c, mean blood glucose (BG), coefficient of variation (CV), and hypoglycemia increased with increasing HbA1c, and were higher for DM-INS than for DM-No-INS. Among patients with HbA1c < 6.5%, mean BG ≥ 180 mg/dL and CV > 30% were associated with lower severity-adjusted mortality in DM-INS compared to patients with mean BG 80-140 mg/dL and CV < 15%, (P = .0058 and < .0001, respectively), but higher severity-adjusted mortality among DM-No-INS (P = .0001 and < .0001, respectively) and NON-DM (P < .0001 and < .0001, respectively). Among patients with HbA1c ≥ 8.0%, mean BG ≥ 180 mg/dL was associated with lower severity-adjusted mortality for both DM-INS and DM-No-INS than was mean BG 80-140 mg/dL (p < 0.0001 for both comparisons). CONCLUSIONS Significant differences in mortality were found among patients with diabetes based on insulin treatment and HbA1c at home and post-admission glycemic control. Prospective studies need to confirm an individualized approach to glycemic control in the critically ill.
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Affiliation(s)
- James S. Krinsley
- Division of Critical Care, Department
of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and
Surgeons, Stamford, CT, USA
- James S Krinsley MD, FCCM, FCCP, Division
of Critical Care, Department of Medicine, Stamford Hospital, and the Columbia
Vagelos College of Physicians and Surgeons, 1 Hospital Plaza, Stamford, CT
06902, USA. Emails: ;
| | | | - Michael Brownlee
- Einstein Diabetes Research Center,
Professor of Medicine and Pathology Emeritus, Albert Einstein College of Medicine,
Bronx, NY, USA
| | | | | | - Sherose Chaudry
- Division of Critical Care, Department
of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and
Surgeons, Stamford, CT, USA
| | - Krista Dionne
- Division of Critical Care, Department
of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and
Surgeons, Stamford, CT, USA
| | - Camilla Heluey-Rodrigues
- Division of Critical Care, Department
of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and
Surgeons, Stamford, CT, USA
| | | | - Irl B. Hirsch
- University of Washington Medicine
Diabetes Institute, Seattle, WA, USA
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10
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Nejatian MM, Lan NSR, Yeap BB, Dwivedi G, Fegan PG, Ihdayhid AR. Characteristics and outcomes of patients with type 1 diabetes admitted with acute coronary syndromes. Diabetes Res Clin Pract 2022; 192:110093. [PMID: 36206818 DOI: 10.1016/j.diabres.2022.110093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022]
Abstract
AIMS This study explored characteristics and outcomes of patients with type 1 diabetes mellitus (T1DM) and acute coronary syndromes (ACS). METHODS A retrospective analysis of patients with T1DM admitted with ACS to an Australian hospital was conducted. Risk factor targets were defined by 2021 European Society of Cardiology Guidelines. Outcomes were defined as an adverse cardiovascular event (ACS, unplanned revascularisation, heart failure, stroke, or cardiovascular death) or all-cause mortality within six-months after discharge. RESULTS 61 patients were included [age 58.5 ± 12.8 years, 39 % female]. Dyslipidaemia (85 %), hypertension (75 %), smoking (28 %), prior coronary artery disease (CAD) (44 %), and microvascular complications (62 %) were common. HbA1c, low-density lipoprotein cholesterol, and blood pressure targets were attained in 12 %, 36 % and 47 %, respectively. ST-elevation myocardial infarction (65 % versus 7 %, p < 0.001) and revascularisation (77 % versus 41 %, p = 0.008) were more common in those without prior CAD. Peak inpatient blood glucose correlated directly with peak troponin (p = 0.011) and inversely with left ventricular ejection fraction (p = 0.027). Nineteen patients experienced an adverse six-month outcome, with peripheral neuropathy (p = 0.039) and in-hospital hypoglycaemia (p = 0.012) being independent predictors. CONCLUSIONS Patients with T1DM and ACS often do not meet guideline targets for cardiovascular risk factors, and frequently present with transmural infarctions. Dysglycemia and microvascular complications predict poorer outcomes.
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Affiliation(s)
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia, Perth, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia
| | - P Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia
| | - Abdul R Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia.
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11
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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12
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Khan SA, Shields S, Abusamaan MS, Mathioudakis N. Association between dysglycemia and the Charlson Comorbidity Index among hospitalized patients with diabetes. J Diabetes Complications 2022; 36:108305. [PMID: 36108545 DOI: 10.1016/j.jdiacomp.2022.108305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 01/08/2023]
Abstract
AIM Inpatient dysglycemia has been linked to short-term mortality, but longer-term mortality data are lacking. Our aim was to evaluate the association between inpatient dysglycemia and one-year mortality risk. METHODS Retrospective chart review of adults with diabetes hospitalized between 2015 and 2019. The Charlson Comorbidity Index (CCI) was used to estimate 1-year mortality risk, stratified into low (CCI ≤ 5) and high risk (CCI ≥6). Simple and multivariable logistic regression was used to evaluate the association between dysglycemic measures and high mortality risk. RESULTS Among 22,639 unique admissions, BG ≥ 180, ≥300, ≤70, <54 and <40 mg/dL were associated with adjusted odds of 1.43 (95 % CI, 1.33, 1.54), 1.58 (95 % CI, 1.48, 1.68), 2.16 (95 % CI, 2.01, 2.32), 2.58 (95 % CI, 2.32, 2.86), and 2.56 (95 % CI, 2.19, 2.99) for high mortality risk, respectively. Older age and Black race were positively associated with hyperglycemia and hypoglycemia. Myocardial infarction, congestive heart failure (CHF), and moderate to severe liver disease were most strongly associated with hyperglycemia, while renal disease, CHF, peripheral vascular disease, and peptic ulcer disease were most strongly associated with hypoglycemia. CONCLUSIONS Inpatient hypoglycemia and hyperglycemia were both positively associated with higher one-year mortality risk, with stronger magnitude of association observed for hypoglycemia. The association appears to be mediated mainly by presence of diabetes-related complications.
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Affiliation(s)
- Sara Atiq Khan
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Stephen Shields
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Mohammed S Abusamaan
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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13
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Cheng SY, Wang H, Lin SH, Wen JH, Ma LL, Dai XC. Association of admission hyperglycemia and all-cause mortality in acute myocardial infarction with percutaneous coronary intervention: A dose–response meta-analysis. Front Cardiovasc Med 2022; 9:932716. [PMID: 36172574 PMCID: PMC9510712 DOI: 10.3389/fcvm.2022.932716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The aim of this study is to evaluate the associations between admission hyperglycemia and the risk of all-cause mortality in patients with acute myocardial infarction (AMI) with or without diabetes, to find optimal admission glucose intervention cut-offs, and to clarify the shape of the dose–response relations. Methods Medline/PubMed and EMBASE were searched from inception to 1 April 2022. Cohort studies reporting estimates of all-cause mortality risk in patients with admission hyperglycemia with AMI were included. The outcomes of interest include mortality and major adverse cardiac events (MACEs). A random effect dose–response meta-analysis was conducted to access linear trend estimations. A one-stage linear mixed effect meta-analysis was used for estimating dose–response curves. Relative risks and 95% confidence intervals were pooled using a random-effects model. Results Of 1,222 studies screened, 47 full texts were fully reviewed for eligibility. The final analyses consisted of 23 cohort studies with 47,177 participants. In short-term follow-up, admission hyperglycemia was associated with an increased risk of all-cause mortality (relative risk: 3.12, 95% confidence interval 2.42–4.02) and MACEs (2.34, 1.77–3.09). In long-term follow-up, admission hyperglycemia was associated with an increased risk of all-cause mortality (1.97, 1.61–2.41) and MACEs (1.95, 1.21–3.14). A linear dose–response association was found between admission hyperglycemia and the risk of all-cause mortality in patients with or without diabetes. Conclusion Admission hyperglycemia was significantly associated with higher all-cause mortality risk and rates of MACEs. However, the association between admission hyperglycemia and long-term mortality risk needs to be determined with caution. Compared with current guidelines recommendations, a lower intervention cut-off and more stringent targets for admission hyperglycemia may be appropriate. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022317280], identifier [CRD42022317280].
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Affiliation(s)
- Shao-Yong Cheng
- Department of Cardiology, Beijing Royal Integrative Medicine Hospital, Beijing, China
| | - Hao Wang
- Department of Cardiology, Beijing Royal Integrative Medicine Hospital, Beijing, China
| | - Shi-Hua Lin
- Department of Internal Medicine, Zhejiang Hospital, Hangzhou, China
| | - Jin-Hui Wen
- Department of Endocrinology and Metabolism, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Ling-Ling Ma
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, China
- *Correspondence: Ling-Ling Ma,
| | - Xiao-Ce Dai
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, China
- Xiao-Ce Dai,
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14
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Vedantam D, Poman DS, Motwani L, Asif N, Patel A, Anne KK. Stress-Induced Hyperglycemia: Consequences and Management. Cureus 2022; 14:e26714. [PMID: 35959169 PMCID: PMC9360912 DOI: 10.7759/cureus.26714] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 01/08/2023] Open
Abstract
Hyperglycemia during stress is a common occurrence seen in patients admitted to the hospital. It is defined as a blood glucose level above 180mg/dl in patients without pre-existing diabetes. Stress-induced hyperglycemia (SIH) occurs due to an illness that leads to insulin resistance and decreased insulin secretion. Such a mechanism causes elevated blood glucose and produces a complex state to manage with external insulin. This article compiles various studies to explain the development and consequences of SIH in the critically ill that ultimately lead to an increase in mortality while also discussing the dire impact of SIH on certain acute illnesses like myocardial infarction and ischemic stroke. It also evaluates multiple studies to understand the management of SIH with insulin and proper nutritional therapy in the hospitalized patients admitted to the Intensive care unit (ICU) alongside the non-critical care unit. While emphasizing the diverse effects of improper control of SIH in the hospital, this article elucidates and discusses the importance of formulating a discharge plan due to an increased risk of type 2 diabetes in the recovered.
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15
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Kirmani TA, Singh M, Kumar S, Kumar K, Parkash O, Sagar, Yasmin F, Khan F, Chughtai N, Asghar MS. Plasma random glucose levels at hospital admission predicting worse outcomes in STEMI patients undergoing PCI: A case series. Ann Med Surg (Lond) 2022; 78:103857. [PMID: 35734745 PMCID: PMC9207087 DOI: 10.1016/j.amsu.2022.103857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
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16
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The Impact of Hypoglycemic Therapy on the Prognosis for Acute Coronary Syndrome in Patients with Type 2 Diabetes. J Pers Med 2022; 12:jpm12050845. [PMID: 35629267 PMCID: PMC9143707 DOI: 10.3390/jpm12050845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
The article discusses particular circumstances of acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D). In addition, the available literature data and clinical guidelines reflecting the role of hypoglycemic therapy as a cardioprotection factor in ACS are analyzed. The article considers possible protective molecular mechanisms of various groups of drugs in ischemic cardiomyocytes.
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17
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Moon SJ, Choe HJ, Kwak SH, Jung HS, Park KS, Cho YM. Comparison of Prevailing Insulin Regimens at Different Time Periods in Hospitalized Patients: A Real-World Experience from a Tertiary Hospital. Diabetes Metab J 2022; 46:439-450. [PMID: 34666425 PMCID: PMC9171166 DOI: 10.4093/dmj.2021.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prevailing insulin regimens for glycemic control in hospitalized patients have changed over time. We aimed to determine whether the current basal-bolus insulin (BBI) regimen is superior to the previous insulin regimen, mainly comprising split-mixed insulin therapy. METHODS This was a single tertiary center, retrospective observational study that included non-critically ill patients with type 2 diabetes mellitus who were treated with split-mixed insulin regimens from 2004 to 2007 (period 1) and with BBI from 2008 to 2018 (period 2). Patients from each period were analyzed after propensity score matching. The mean difference in glucose levels and the achievement of fasting and preprandial glycemic targets by day 6 of admission were assessed. The total daily insulin dose, incidence of hypoglycemia, and length of hospital stay were also evaluated. RESULTS Among 244 patients from each period, both fasting glucose (estimated mean±standard error, 147.4±3.1 mg/dL vs. 129.4±3.2 mg/dL, P<0.001, day 6) and preprandial glucose (177.7±2.8 mg/dL vs. 152.8±2.8 mg/dL, P<0.001, day 6) were lower in period 2 than in period 1. By day 6 of hospital admission, 42.6% and 67.2% of patients achieved a preprandial glycemic target of <140 mg/dL in periods 1 and 2, respectively (relative risk, 2.00; 95% confidence interval, 1.54 to 2.59), without an increased incidence of hypoglycemia. Length of stay was shorter in period 2 (10.23±0.26 days vs. 8.70±0.26 days, P<0.001). CONCLUSION BBI improved glycemic control in a more efficacious manner than a split-mixed insulin regimen without increasing the risk of hypoglycemia in a hospital setting.
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Affiliation(s)
- Sun Joon Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hun Jee Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hye Seung Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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18
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Ware LR, Gilmore JF, Szumita PM. Practical approach to clinical controversies in glycemic control for hospitalized surgical patients. Nutr Clin Pract 2022; 37:521-535. [PMID: 35490289 DOI: 10.1002/ncp.10858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/17/2022] [Accepted: 03/30/2022] [Indexed: 11/11/2022] Open
Abstract
The importance of glycemic management in surgical patient populations stems from an association between hyperglycemia and increased rates of surgical site infections, sepsis, and mortality. Various guidelines provide recommendations regarding target glucose concentrations, but all stress the importance of avoiding hypoglycemia as well. Within the surgical patient population, glycemic targets may vary further depending on the surgical service, such as cardiac surgery, neurosurgery, or reconstructive burn surgery. Glycemic management in critically ill surgical patients is achieved primarily through the use of intravenous insulin infusion protocols. These protocols can include fixed protocols, multiplication factor protocols, and computerized algorithms. In contrast, noncritically ill surgical patients are generally managed through the utilization of subcutaneous insulin with a combination of basal, bolus, and sliding scale insulin. Insulin protocols should be effective at maintaining glucose concentrations within the specified target range with minimal hypoglycemic events. Monitoring glucose concentrations while on either an intravenous or subcutaneous insulin protocol is essential. Point-of-care testing is the primary method for monitoring glucose concentrations in both critically ill and noncritically ill surgical patients and allows for adjustment of the insulin regimen. As patients move between units and to the outpatient setting, ensuring adequate follow-up is essential to maintaining control of hyperglycemia.
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Affiliation(s)
- Lydia R Ware
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James F Gilmore
- Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Paul M Szumita
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
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19
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Fadini GP. Perturbation of Glucose Homeostasis During Acute Illness: Stress Hyperglycemia and Relative Hypoglycemia. Diabetes Care 2022; 45:769-771. [PMID: 35349655 DOI: 10.2337/dci21-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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20
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Choi SH, Jang HJ, Suh YJ, Park SD, Oh PC, Moon J, Lee K, Suh J, Kang W, Kim TH, Kwon SW. Clinical Implication of Hypoxic Liver Injury for Predicting Hypoxic Hepatitis and In-Hospital Mortality in ST Elevation Myocardial Infarction Patients. Yonsei Med J 2021; 62:877-884. [PMID: 34558866 PMCID: PMC8470566 DOI: 10.3349/ymj.2021.62.10.877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In this study, we aimed to determine the value of hypoxic liver injury (HLI) in the emergency room (ER) for predicting hypoxic hepatitis (HH) and in-hospital mortality in ST elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS 1537 consecutive STEMI patients were enrolled. HLI in the ER was defined as a ≥2-fold increase in serum aspartate transaminase (AST). HH was defined as a ≥20-fold increase in peak serum transaminase. Patients were divided into four groups according to HLI and HH status (group 1, no HLI or HH; group 2, HLI, but no HH; group 3, no HLI, but HH; group 4, both HLI and HH). RESULTS The incidences of HLI and HH in the ER were 22% and 2%, respectively. In-hospital mortality rates were 3.1%, 11.8%, 28.6%, and 47.1% for groups 1, 2, 3, and 4, respectively. Patients with HLI and/or HH had worse Killip class, higher cardiac biomarker elevations, and lower left ventricular ejection fraction. Multivariate logistic regression analysis showed that HLI in the ER was an independent predictor of HH [odds ratio 2.572, 95% confidence interval (CI) 1.166-5.675, p=0.019]. The predictive value of HLI in the ER for the development of HH during hospitalization was favorable [area under the curve (AUC) 0.737, 95% CI 0.643-0.830, sensitivity 0.548, specificity 0.805, for cut-off value AST >80]. Furthermore, in terms of in-hospital mortality, predictive values of HLI in the ER and HH during hospitalization were comparable (AUC 0.701 for HLI at ER and AUC 0.674 for HH). CONCLUSION Among STEMI patients, HLI in the ER is a significant predictor for the development of HH and mortality during hospitalization (INTERSTELLAR ClinicalTrials.gov number, NCT02800421).
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Affiliation(s)
- Seong Huan Choi
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Ho-Jun Jang
- Department of Cardiology, Sejong General Hospital, Bucheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Korea
| | - Sang-Don Park
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jeonggeun Moon
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kyounghoon Lee
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jon Suh
- Department of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - WoongChol Kang
- Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, CHA Medical Center, Ilsan Hospital, Goyang, Korea.
| | - Sung Woo Kwon
- Department of Cardiology, Inha University Hospital, Incheon, Korea.
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21
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Qin Y, Qiao Y, Wang D, Tang C, Yan G. Admission Hyperglycemia is Associated with Global Registry of Acute Coronary Events Score and Complications Following Acute Myocardial Infarction During 1-Year Follow-Up. Angiology 2021; 73:165-176. [PMID: 34428380 DOI: 10.1177/00033197211039915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We explored the effect of admission hyperglycemia (AH) on the Global Registry of Acute Coronary Events (GRACE) risk score and major adverse cardiovascular and cerebrovascular event (MACCE) incidence during 1-year follow-up in acute myocardial infarction (AMI) patients. In this retrospective observational study enrolling 1098 AMI patients, hyperglycemia was defined as blood glucose level ≥180 mg/dl at admission. Overall, 158 and 84 patients of 272 diabetic and 826 non-diabetic patients were diagnosed with AH, respectively. Glucose levels at admission were closely associated with the GRACE score in patients with/without diabetes. MACCEs occurred in 222 patients; patients with AH showed significantly higher MACCE incidence (28.1%). Multivariate Cox logistic regression analysis indicated that AH was an independent risk factor for 1-year MACCEs. Subgroup analysis demonstrated that hyperglycemia increases MACCE risk in non-diabetic patients but not in diabetic patients. The admission glucose level combined with GRACE risk score showed a certain predictive value for MACCE incidence according to ROC analysis (OR = 0.798, p < .001). AH was strongly associated with a higher GRACE risk score in ST-segment elevation myocardial infarction patients. Thus, AH was an independent risk factor and had a high predictive value for MACCE during 1-year follow-up after AMI.
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Affiliation(s)
- Yuhan Qin
- Department of Cardiology, School of Medicine, 162752Southeast University Zhongda Hospital, Nanjing, P. R. China
| | - Yong Qiao
- Department of Cardiology, School of Medicine, 162752Southeast University Zhongda Hospital, Nanjing, P. R. China
| | - Dong Wang
- Department of Cardiology, School of Medicine, 162752Southeast University Zhongda Hospital, Nanjing, P. R. China
| | - Chengchun Tang
- Department of Cardiology, School of Medicine, 162752Southeast University Zhongda Hospital, Nanjing, P. R. China
| | - Gaoliang Yan
- Department of Cardiology, School of Medicine, 162752Southeast University Zhongda Hospital, Nanjing, P. R. China
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22
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Caturano A, Galiero R, Pafundi PC, Cesaro A, Vetrano E, Palmiero G, Rinaldi L, Salvatore T, Marfella R, Sardu C, Moscarella E, Gragnano F, Calabrò P, Sasso FC. Does a strict glycemic control during acute coronary syndrome play a cardioprotective effect? Pathophysiology and clinical evidence. Diabetes Res Clin Pract 2021; 178:108959. [PMID: 34280467 DOI: 10.1016/j.diabres.2021.108959] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/08/2023]
Abstract
A hyperglycemic state, also in non-diabetic subjects, may be associated with acute coronary syndrome (ACS). Aim of this review is to describe the pathophysiologic association between ACS and hyperglycemic state, the protective mechanisms of a tight glycaemic control in ACS on CV outcomes, and the supporting clinical evidence. Several mechanisms may be responsible of a poor CV outcome in subjects with hyperglycemia during ACS. Endothelial NAPDH oxidase-2 (NOX2) activation in response to high glucose alters the balance between Raf/MAPK-dependent vasoconstriction and PI3K/Akt-dependent vasodilation in favour of constriction. Hyperglycaemia induces an overproduction of superoxide by the mitochondrial electron transport chain through different molecular mechanisms. Moreover, hyperglycaemia increases the size of the infarct by causing myocardial cell death through apoptosis and reducing the collateral blood flow. High FFA concentrations lead to toxicity mechanisms in acutely ischemic myocardium. On the other hand, a tight glycaemic control in ACS exerts a cardioprotective action by anti-inflammatory and anti-apoptotic mechanisms, anti-oxidative stress, endothelium protection, FFA reduction, anti-glucotoxic effect, IR and cardiac fuel metabolisms improvement, heart stem cells protection and reduced activation of adrenergic system. Unfortunately, the clinical studies supporting the above pathophysiological background are few and sometimes controversial, more likely due the risk of hypoglycemia linked to the insulin therapy generally used during ACS. Intriguingly, GLP-1 RA and SGLT2i, demonstrated highly effective in the cardiovascular prevention in high-risk subjects without the risk of hypoglycemia, might keep this cardioprotective effect even in acute conditions such as ASC.
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Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", 81100 Caserta, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy
| | - Teresa Salvatore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Via De Crecchio 7, I-80138 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", 81100 Caserta, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", 81100 Caserta, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", 81100 Caserta, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, I-80138 Naples, Italy.
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23
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Mamadjanov T, Volaklis K, Heier M, Freuer D, Amann U, Peters A, Kuch B, Thilo C, Linseisen J, Meisinger C. Admission glucose level and short-term mortality in older patients with acute myocardial infarction: results from the KORA Myocardial Infarction Registry. BMJ Open 2021; 11:e046641. [PMID: 34083341 PMCID: PMC8183232 DOI: 10.1136/bmjopen-2020-046641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES To investigate the association between admission blood glucose levels and 28-day mortality as well as in-hospital complications in older patients with incident acute myocardial infarction (AMI) undergoing modern treatment. METHODS From a German population-based regional MI registry, 5530 patients (2016 women), aged 65-84 years, hospitalised with an incident AMI between 1 January 2009 and 31 December 2016 were included in the study. Multivariable logistic regression models were used to assess the associations between admission blood glucose and 28-day mortality as well as in-hospital complications after AMI. Analyses stratified according to age, diabetes and type of infarction (ST-elevation MI (STEMI)/non-STEMI) were conducted. RESULTS The adjusted ORs for the association between admission blood glucose and 28-day mortality in young-old (65-74 years) and old (75-84 years) patients with AMI were 1.40 (95% CI: 1.21 to 1.62) and 1.21 (95% CI: 0.98 to 1.50) per 1 SD increase in admission blood glucose, respectively. Furthermore, higher admission blood glucose was related to case fatality irrespective of the diabetes status and type of infarction only in the under-75 group. For the patients aged 75-84 years, it was only true for those without diabetes and STEMI. Admission blood glucose was also associated with major cardiac complications in both age groups. CONCLUSION Admission blood glucose was significantly associated with 28-day case fatality in patients with AMI aged 65-74 years but not 75-84 years; furthermore, in both age groups there was an increased risk of major complications. It seems that admission glucose may play a rather minor role in terms of case fatality in higher aged patients with AMI.
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Affiliation(s)
- Temur Mamadjanov
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munchen, Germany
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Konstantinos Volaklis
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Dennis Freuer
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Ute Amann
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - B Kuch
- Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Christian Thilo
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
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Jordán-Domingo M, Gimeno-Orna JA, Lahoza-Pérez MC, Ilundain-González AI, Agudo-Tabuenca A, Sáenz-Abad D. Effect of in-hospital glycemic variability on mortality in patients with diabetes. Rev Clin Esp 2021; 221:323-330. [PMID: 32646753 DOI: 10.1016/j.rce.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/03/2019] [Accepted: 12/22/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBG >140mg/dl (HR, 1.72; 95% CI 1.14-2.61; p=.01) and a CV >0.29 (HR, 1.52; 95% CI 1.12-2.06; p=.006) but not the presence of hypoglycaemia were additively and independently associated with an increased risk of mortality. An MBG >140mg/dl with a CV >0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p <.001) and the adjusted mortality risk (HR, 2.70; 95% CI 1.71-4.27; p<.001) compared with having an MBG ≤140mg/dl. CONCLUSION The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.
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Affiliation(s)
- M Jordán-Domingo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J A Gimeno-Orna
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M C Lahoza-Pérez
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A I Ilundain-González
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A Agudo-Tabuenca
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - D Sáenz-Abad
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
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25
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Li M, Chen G, Feng Y, He X. Stress Induced Hyperglycemia in the Context of Acute Coronary Syndrome: Definitions, Interventions, and Underlying Mechanisms. Front Cardiovasc Med 2021; 8:676892. [PMID: 34055942 PMCID: PMC8149624 DOI: 10.3389/fcvm.2021.676892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023] Open
Abstract
Elevation of glucose level in response to acute coronary syndrome (ACS) has been recognized as stress induced hyperglycemia (SIH). Plenty of clinical studies have documented that SIH occurs very common in patients hospitalized with ACS, even in those without previously known diabetes mellitus. The association between elevated blood glucose levels with adverse outcome in the ACS setting is well-established. Yet, the precise definition of SIH in the context of ACS remains controversial, bringing confusions about clinical management strategy. Several randomized trials aimed to evaluate the effect of insulin-based therapy on outcomes of ACS patients failed to demonstrate a consistent benefit of intensive glucose control. Mechanisms underlying detrimental effects of SIH on patients with ACS are undetermined, oxidative stress might play an important role in the upstream pathways leading to subsequent harmful effects on cardiovascular system. This review aims to discuss various definitions of SIH and their values in predicting adverse outcome in the context of ACS, as well as the effect of intensive glucose control on clinical outcome. Finally, a glimpse of the underlying mechanisms is briefly discussed.
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Affiliation(s)
- Mingmin Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuyu He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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26
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Demidowich AP, Batty K, Love T, Sokolinsky S, Grubb L, Miller C, Raymond L, Nazarian J, Ahmed MS, Rotello L, Zilbermint M. Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting. J Diabetes Sci Technol 2021; 15:546-552. [PMID: 33615858 PMCID: PMC8120056 DOI: 10.1177/1932296821993198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting. METHODS This retrospective study examined the effects of changing the model of inpatient diabetes consultations from a local, private endocrine practice to a full-time endocrine hospitalist on glycemic control, LOS, and 30-day readmission rates in a 267-bed community hospital. RESULTS Overall diabetes patient days for the hospital were similar pre- and post-intervention (20,191 vs 20,262); however, the volume of patients seen by IDMS increased significantly after changing models. Rates of hyperglycemia decreased both among patients seen by IDMS (53.8% to 42.5%, P < .0001) and those not consulted on by IDMS (33.2% to 29.9%; P < .0001). When examined over time, rates of hypoglycemia steadily decreased in the 24 months after dedicated IDMS initiation (P = .02); no such time effect was seen prior to IDMS (P = .34). LOS and 30DRR were not significantly different between IDMS models. CONCLUSIONS Implementation of an endocrine hospitalist-based IDMS at a community hospital was associated with significantly decreased hyperglycemia, while avoiding concurrent increases in hypoglycemia. Further studies are needed to investigate whether these effects are associated with improvements in clinical outcomes, patient or staff satisfaction scores, or total cost of care.
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Affiliation(s)
- Andrew P. Demidowich
- Johns Hopkins Community Physicians
at Howard County General Hospital (HCGH), Division of Hospital Medicine,
Johns Hopkins Medicine, Columbia, MD, USA
- Division of Endocrinology,
Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of
Medicine, Baltimore, MD, USA
- Andrew P. Demidowich, MD, Assistant
Professor of Medicine, Johns Hopkins Medicine, Howard County General
Hospital, 5755 Cedar Ln, Columbia, MD 21044, USA.
| | - Kristine Batty
- Johns Hopkins Community Physicians
at Howard County General Hospital (HCGH), Division of Hospital Medicine,
Johns Hopkins Medicine, Columbia, MD, USA
| | - Teresa Love
- Rehab Services, Diabetes
Management & The Center for Wound Healing, HCGH, Johns Hopkins Medicine,
Columbia, MD, USA
| | - Sam Sokolinsky
- JHHS Quality and Clinical
Analytics, Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD,
USA
| | - Lisa Grubb
- Johns Hopkins Armstrong Institute
at HCGH, Johns Hopkins Medicine, Columbia, MD, USA
| | - Catherine Miller
- Division of Nursing – Critical
Care, HCGH, Johns Hopkins Medicine, Columbia, MD, USA
| | - Larry Raymond
- Rehab Services, Diabetes
Management & The Center for Wound Healing, HCGH, Johns Hopkins Medicine,
Columbia, MD, USA
| | - Jeanette Nazarian
- Johns Hopkins Community Physicians
at Howard County General Hospital (HCGH), Division of Hospital Medicine,
Johns Hopkins Medicine, Columbia, MD, USA
| | - M. Shafeeq Ahmed
- Johns Hopkins Armstrong Institute
at HCGH, Johns Hopkins Medicine, Columbia, MD, USA
| | - Leo Rotello
- Johns Hopkins Community Physicians
at Suburban Hospital, Division of Hospital Medicine, Johns Hopkins Medicine,
Bethesda, MD, USA
| | - Mihail Zilbermint
- Division of Endocrinology,
Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of
Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians
at Suburban Hospital, Division of Hospital Medicine, Johns Hopkins Medicine,
Bethesda, MD, USA
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27
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Jordán-Domingo M, Gimeno-Orna JA, Lahoza-Pérez MC, Ilundain-González AI, Agudo-Tabuenca A, Sáenz-Abad D. Effect of in-hospital glycemic variability on mortality in patients with diabetes. Rev Clin Esp 2021; 221:323-330. [PMID: 34059229 DOI: 10.1016/j.rceng.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/22/2019] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis. The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBG > 140 mg/dL (HR = 1.72; 95% CI 1.14-2.61; p = .01) and a CV > 0.29 (HR = 1.52; 95% CI 1.12-2.06; p = .006), but not the presence of hypoglycaemia, were additively and independently associated with an increased risk of mortality. An MG > 140 mg/dL with a CV > 0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p < .001) and the adjusted mortality risk (HR = 2.70; 95% CI 1.71-4.27; p < .001) compared with having an MBG ≤ 140 mg/dL. CONCLUSION The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.
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Affiliation(s)
- M Jordán-Domingo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J A Gimeno-Orna
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M C Lahoza-Pérez
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A I Ilundain-González
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Agudo-Tabuenca
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - D Sáenz-Abad
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
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Gao S, Liu Q, Chen H, Yu M, Li H. Predictive value of stress hyperglycemia ratio for the occurrence of acute kidney injury in acute myocardial infarction patients with diabetes. BMC Cardiovasc Disord 2021; 21:157. [PMID: 33781208 PMCID: PMC8008672 DOI: 10.1186/s12872-021-01962-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background Acute hyperglycemia has been recognized as a robust predictor for occurrence of acute kidney injury (AKI) in nondiabetic patients with acute myocardial infarction (AMI), however, its discriminatory ability for AKI is unclear in diabetic patients after an AMI. Here, we investigated whether stress hyperglycemia ratio (SHR), a novel index with the combined evaluation of acute and chronic glycemic levels, may have a better predictive value of AKI as compared with admission glycemia alone in diabetic patients following AMI. Methods SHR was calculated with admission blood glucose (ABG) divided by the glycated hemoglobin-derived estimated average glucose. A total of 1215 diabetic patients with AMI were enrolled and divided according to SHR tertiles. Baseline characteristics and outcomes were compared. The primary endpoint was AKI and secondary endpoints included all-cause death and cardiogenic shock during hospitalization. The logistic regression analysis was performed to identify potential risk factors. Accuracy was defined with area under the curve (AUC) by a receiver-operating characteristic (ROC) curve analysis. Results In AMI patients with diabetes, the incidence of AKI (4.4%, 7.8%, 13.0%; p < 0.001), all-cause death (2.7%, 3.6%, 6.4%; p = 0.027) and cardiogenic shock (4.9%, 7.6%, 11.6%; p = 0.002) all increased with the rising tertile levels of SHR. After multivariate adjustment, elevated SHR was significantly associated with an increased risk of AKI (odds ratio 3.18, 95% confidence interval: 1.99–5.09, p < 0.001) while ABG was no longer a risk factor of AKI. The SHR was also strongly related to the AKI risk in subgroups of patients. At ROC analysis, SHR accurately predicted AKI in overall (AUC 0.64) and a risk model consisted of SHR, left ventricular ejection fraction, N-terminal B-type natriuretic peptide, and estimated glomerular filtration rate (eGFR) yielded a superior predictive value (AUC 0.83) for AKI. Conclusion The novel index SHR is a better predictor of AKI and in-hospital mortality and morbidity than admission glycemia in AMI patients with diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01962-2.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Yongan Road 95, Xicheng District, 100050, Beijing, China.,Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Road 167, Xicheng District, 100037, Beijing, China
| | - Qingbo Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Yongan Road 95, Xicheng District, 100050, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Yongan Road 95, Xicheng District, 100050, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Road 167, Xicheng District, 100037, Beijing, China.
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Yongan Road 95, Xicheng District, 100050, Beijing, China.
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29
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Pearson SM, Whittam B, Kulavarasalingam K, Mitchell-Gears A, James C, Ajjan RA. Reduction in cardiovascular mortality following severe hypoglycemia in individuals with type 2 diabetes: the role of a pragmatic and structured intervention : Structured intervention for community hypoglycemia. Cardiovasc Diabetol 2021; 20:18. [PMID: 33435992 PMCID: PMC7802275 DOI: 10.1186/s12933-020-01204-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Mortality in individuals with diabetes with severe hypoglycemia requiring ambulance services intervention is high and it is unclear whether this is modifiable. Our aim was to characterise this high-risk group and assess the impact of nurse-led intervention on mortality. Methods In this single centre study, patients with diabetes and hypoglycemia requiring ambulance call out were randomized to nurse led support (intensive arm) or managed using existing pathways (standard arm). A third group agreed to have their data collected longitudinally (observational arm). The primary outcome was all-cause mortality comparing intensive with combined standard and observational arms as well as standard arm alone. Results Of 828 individuals identified, 323 agreed to participate with 132 assigned to intensive, 130 to standard and 61 to observational arms. Mean follow up period was 42.6 ± 15.6 months. Mortality in type 1 diabetes (n = 158) was similar across study arms but in type 2 diabetes (n = 160) this was reduced to 33% in the intensive arm compared with 51% in the combined arm (p = 0.025) and 50% in the standard arm (p = 0.06). Cardiovascular deaths, the leading cause of mortality, was lower in the intensive arm compared with combined and standard study arms (p < 0.01). Conclusions Medium-term mortality following severe hypoglycemia requiring the assistance of emergency services is high in those with type 2 diabetes. In individuals with type 2 diabetes, nurse-led individualized intervention reduces cardiovascular mortality compared with standard care. Large-scale multicentre studies are warranted to further investigate this approach. Trial registration The trial was retrospectively registered on http://www.clinicaltrials.gov with reference NCT04422145
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Affiliation(s)
- Sam M Pearson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | | | | | - Amelia Mitchell-Gears
- Leeds Institute of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | | | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK. .,The LIGHT Laboratories, Centre for Diabetes and Vascular Research, Leeds, UK.
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Chen P, Chen L, Zhao X, Sun Q. The Association of Mean Plasma Glucose and In hospital Death Proportion: A Retrospective, Cohort Study of 162,169 In-Patient Data. Int J Endocrinol 2021; 2021:1513683. [PMID: 33531898 PMCID: PMC7834774 DOI: 10.1155/2021/1513683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/12/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS To investigate the association between mean plasma glucose and inhospital death proportion. METHODS We retrospectively collected 162,169 inpatient data in Huashan Hospital from January 2012 to December 2015. Mean plasma glucose was calculated and considered as the average glycemia control during hospitalization. Patients were stratified into six groups according to mean plasma glucose. Nonlinear regression was performed to determine the associations between mean plasma glucose and inhospital death proportion, medical cost, and length of stay. Multivariate logistic regressions were performed to evaluate the relationship of mean plasma glucose and outcomes controlling for confounders including age, gender, and others. Subgroup analyses were performed on basis of whether they were surgical patients, ICU patients, patients with diabetes, or others. RESULTS Of the 162,169 hospitalized participants, 53.32% were male and 989 died during hospitalization. Nonlinear regression showed there were positive and significant associations between mean plasma glucose and death proportion, medical cost, and length of stay (P < 0.001 for all). Multivariate logistic regressions showed that, compared with group B, a statistically significant association between mean plasma glucose and predicted outcome was apparent, with the odds ratios (95% confidence interval) of 5.79 (3.51-9.55), 2.85 (2.40-3.38), 6.29 (5.24-7.54), 9.34 (7.51-11.62), and 23.52 (16.64-33.26), for group A, group C, group D, group E, and group F, respectively. There was a U-shaped association between mean plasma glucose and death proportion. Subgroup analyses showed similar associations between mean plasma glucose and death proportion, medical cost, and length of stay as in the whole sample. CONCLUSIONS There was a U-curve association between mean plasma glucose with inhospital death proportion. Mean plasma glucose was associated positively with medical cost and length of stay.
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Affiliation(s)
- Peili Chen
- Department of Endocrinology, Huashan Hospital Fudan University, Shanghai, China
| | - Lili Chen
- Department of Endocrinology, Huashan Hospital Fudan University, Shanghai, China
| | - Xiaolong Zhao
- Department of Endocrinology, Huashan Hospital Fudan University, Shanghai, China
| | - Quanya Sun
- Department of Endocrinology, Huashan Hospital Fudan University, Shanghai, China
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El Shebiny AA, Elewa GM, Gouda EAG, Hashim RM. Glucose intolerance in intensive care patients: Incidence and outcome. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1864253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ahmed A. El Shebiny
- Anesthesia, ICU, and Pain Management, Faculty of Medicine , Ain Shams University, Cairo, Egypt
| | - Gamal M. Elewa
- Anesthesia, ICU, and Pain Management, Faculty of Medicine , Ain Shams University, Cairo, Egypt
| | | | - Reham Mustafa Hashim
- Anesthesia, ICU, and Pain Management, Faculty of Medicine , Ain Shams University, Cairo, Egypt
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Koraćević G, Mićić S, Stojanović M, Tomašević M, Kostić T, Koraćević M, Janković I. Single prognostic cut-off value for admission glycemia in acute myocardial infarction has been used although high-risk stems from hyperglycemia as well as from hypoglycemia (a narrative review). Prim Care Diabetes 2020; 14:594-604. [PMID: 32988774 DOI: 10.1016/j.pcd.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
All original articles and meta-analysis use the single cut-off value to distinguish high-risk hyperglycemic from other acute myocardial infarction (AMI) patients. The mortality rate is 3.9 times higher in non-diabetic AMI patients with admission glycemia ≥6.1mmol compared to normoglycemic non-diabetic AMI patients. On the other hand, admission hypoglycemia in AMI is an important predictor of mortality. Because both admission hypo- and hyperglycemia correspond to higher in-hospital mortality, this graph is recognized as "J or U shaped curve". The review suggests two cut-off values for admission glycemia for risk assessment in AMI instead of single one because hypoglycemia as well as hyperglycemia represents a high-risk factor.
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Affiliation(s)
- Goran Koraćević
- Department for Cardiovascular Diseases, Clinical Center Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | | | | | - Miloje Tomašević
- Faculty of Medicine, University of Belgrade, Department of Cardiology, Clinical Center Serbia, Belgrade, Serbia
| | - Tomislav Kostić
- Department for Cardiovascular Diseases, Clinical Center Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | - Maja Koraćević
- Faculty of Medicine, University of Niš, Serbia; Innovation Center, University of Niš, Serbia
| | - Irena Janković
- Faculty of Medicine, University of Niš, Serbia; Clinic of Plastic and Reconstructive Surgery, Clinical Center Niš, Serbia
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Hagley SP, Hopper K, Epstein SE. Etiology and prognosis for dogs with abnormal blood glucose concentrations evaluated in an emergency room. J Vet Emerg Crit Care (San Antonio) 2020; 30:567-573. [PMID: 32896093 DOI: 10.1111/vec.12996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/24/2018] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence of glucose abnormalities in nondiabetic dogs presenting to a veterinary emergency room (ER) and their association with underlying disease processes, previous glucocorticoid administration, and overall mortality. DESIGN Single-center, retrospective study from January 2013 to December 2014. SETTING University Teaching Hospital. ANIMALS A total of 660 dogs presenting to an ER with a blood glucose concentration measured within 6 hours of presentation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records from dogs with a blood glucose concentration measured within 6 hours of hospital admission were reviewed. Medications administered prior to blood sampling, the presence of shock, final clinical diagnosis, and survival were recorded. Hypoglycemia and hyperglycemia were defined as a blood glucose <4.4 mmol/L (80 mg/dL) and >6.7 mmol/L (120 mg/dL), respectively. Diabetic patients were removed from analysis. Hyperglycemia was found in 40.1% of dogs, whereas hypoglycemia was present in 9.0%. Hyperglycemia was most often associated with gastrointestinal disease, trauma, neoplasia, and respiratory disease. The most common diseases associated with hypoglycemia were sepsis, gastrointestinal disease, and neoplasia. Dogs in shock or with hyperlactatemia had higher blood glucose values than dogs with normal perfusion and plasma lactate concentrations (P = 0.016 and P < 0.0001, respectively). Mortality was higher in dogs with hyperglycemia (33.2%, P = 0.03) or hypoglycemia (44.6%, P = 0.0024) compared to those with normoglycemia (24.9%). CONCLUSION Dysglycemia in nondiabetic dogs evaluated in an ER was associated with a higher mortality rate than dogs in the same population with normoglycemia. Hyperglycemia in this population was common and may represent a stress response.
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Affiliation(s)
- Simon P Hagley
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, California
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, Davis, California
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, Davis, California
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Gulsen K, Ayca B, Baskurt M, Okcun B, Ersanli MK. Does Tight Glucose Control During the First 24 hours of Hospitalization Reduce Scintigraphic Infarct Size in STEMI Patients? INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lee W, Kim SH, Yoon CH, Suh JW, Cho YS, Youn TJ, Chae IH. Impact of Long-term Glycosylated Hemoglobin in Patients with Acute Myocardial Infarction: a retrospective cohort study. Sci Rep 2020; 10:6726. [PMID: 32317703 PMCID: PMC7174312 DOI: 10.1038/s41598-020-63802-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/06/2020] [Indexed: 01/21/2023] Open
Abstract
Little clinical evidence supports the strict implementation of glycemic control for diabetic patients with AMI. We aimed to demonstrate the effect of long-term glycemic control on mortality in patients with diabetes mellitus after acute myocardial infarction (AMI). Eight hundred and twenty-four consecutive diabetic patients were divided into three groups according to the mean hemoglobin (HbA1c) value: <6% (group A), ≥6% to <7.5% (group B), and ≥7.5% (group C). The best long-term mortality outcome was observed in Group B, followed by groups C and A. Groups B and C were further compared in-depth because the baseline characteristics of group A differed significantly. A Cox regression analysis indicated that Group C was associated with an adjusted hazard ratio (HR) of 1.55 [95% confidence interval (CI): 1.02-2.34, P = 0.038]. An inverse probability of treatment weight analysis was performed to compare groups B and C. Group C had significantly higher mortality, compared to group B (adjusted HR: 1.58; 95% CI: 1.21-2.06, P < 0.001). In conclusion, Glycemic status was associated with the long-term survival outcome in diabetic patients after AMI. However, further study is needed to prove whether HbA1c-targeted glycemic control can effectively improve survival after AMI.
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Affiliation(s)
- Wonjae Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sun-Hwa Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Catargi B, Gerbaud E. Glucose fluctuations and hypoglycemia as new cardiovascular risk factors in diabetes. ANNALES D'ENDOCRINOLOGIE 2020; 82:144-145. [PMID: 32753273 DOI: 10.1016/j.ando.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bogdan Catargi
- Endocrinology-metabolic diseases and cardiology intensive care unit, hôpital Saint-André, Bordeaux university hospital of Bordeaux, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
| | - Edouard Gerbaud
- Endocrinology-metabolic diseases and cardiology intensive care unit, hôpital Saint-André, Bordeaux university hospital of Bordeaux, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
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Qin Y, Yan G, Qiao Y, Wang D, Luo E, Hou J, Tang C. Predictive value of random blood glucose versus fasting blood glucose on in-hospital adverse events in patients with ST-segment elevation acute myocardial infarction. BMC Cardiovasc Disord 2020; 20:95. [PMID: 32103724 PMCID: PMC7045631 DOI: 10.1186/s12872-020-01394-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background We aim to find out the relationship between random blood glucose (RBG), fasting blood glucose (FBG) and in-hospital adverse events in ST-segment elevation acute myocardial infarction (STEMI) patients. We evaluate and compare the predictive value of RBG and FBG on in-hospital adverse events, and give an appropriate cut-off value of RBG and FBG. Method A retrospective study enrolled 958 consecutive AMI patients undergoing emergency coronary angiography at Zhongda Hospital were enrolled from January 1, 2016, to December 31, 2018 was performed. RBG and FBG, baseline data and adverse events were recorded. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as death, nonfatal recurrent myocardial infarction and stroke. Other adverse events included malignant arrhythmia, cardiac shock and hemorrhage. Patients with RBG > 11.1 mmol/L were divided into elevated RBG group. Patients with FBG > 6.1 mmol/L were divided into elevated FBG group. The incidence of in-hospital adverse events were compared in elevated RBG/FBG group and the control group. ROC curve was used to evaluate the predictive value of RBG and FBG on in-hospital adverse events. Result The incidence of death, hemorrhage, cardiac shock and malignant arrhythmia significantly increases in elevated RBG and FBG group. Binary logistic regression showed that age, hypertension, diabetes, FBG and RBG were independent risk factors for in-hospital adverse events in STEMI patients. The AUC and 95% CI of RBG and FBG in predicting death of AMI patients were 0.789, 0.759~0.816; 0.810, 0.783~0.835, respectively. The cut-off values were 13.82 and 7.35 mmol/L. RBG and FBG also had fine predictive value on cardiac shock and malignant arrhythmia, no statistical difference was found in the predictive value on in-hospital adverse events (P = 0.462, P = 0.570, P = 0.694). Conclusion Incidence of in-hospital adverse events significantly increases in AMI patients combined with elevated RBG or FBG. Both RBG and FBG were independent risk factors for in-hospital adverse events, they had good value on predicting in-hospital adverse events and there was no statistical difference in their predictive value.
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Affiliation(s)
- Yuhan Qin
- Medical school of Southeast University, Nanjing, 210009, People's Republic of China
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China
| | - Yong Qiao
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China
| | - Dong Wang
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China
| | - Erfei Luo
- Medical school of Southeast University, Nanjing, 210009, People's Republic of China
| | - Jiantong Hou
- Medical school of Southeast University, Nanjing, 210009, People's Republic of China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China.
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Ham SY, Nam SB, Kwak YL, Kim TL, Park JK, Shim YH. Age-Related Difference in the Effect of Acute Hyperglycemia on Myocardial Ischemia-Reperfusion Injury. J Gerontol A Biol Sci Med Sci 2020; 75:425-431. [PMID: 30596897 DOI: 10.1093/gerona/gly292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 11/14/2022] Open
Abstract
Age and acute hyperglycemia are known risk factors of myocardial ischemia-reperfusion injury. We investigated age-related difference in the effect of acute hyperglycemia on myocardial ischemia-reperfusion injury in Sprague-Dawley rats (young, 3 months; middle-aged, 10-12 months; and old, 22-24 months). The rats received 1.2 g/kg dextrose or normal saline and were subjected to coronary artery occlusion for 45 minutes followed by reperfusion for 240 minutes. Infarct size and ejection fraction were measured. The levels of apoptosis-related proteins (C-PARP, Bcl-2, Bax, and cytochrome c) and autophagy-related proteins (Bnip3, Beclin-1, Atg5, and LC3B-II) were evaluated. Infarct size increased with acute hyperglycemia in young and middle-aged rats but not in old rats, whereas the reduction of ejection fraction after ischemia-reperfusion was aggravated by acute hyperglycemia in all age groups. Acute hyperglycemia increased Bnip3 and Beclin-1 expressions after ischemia-reperfusion in young and middle-aged rats but not in old rats, whereas it increased the expression of Bax, cytochrome c, Atg5, and LC3B-II only in young or middle-aged rats. Conclusively, acute hyperglycemia does not aggravate myocardial ischemia-reperfusion injury in old rats, unlike in young and middle-aged rats. This heterogeneity may be due to attenuated changes in protein signaling after ischemia-reperfusion injury under acute hyperglycemia in old rats.
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Affiliation(s)
- Sung Yeon Ham
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Beom Nam
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Lim Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Kwang Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yon Hee Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Li Y, Li X, Zhang Y, Zhang L, Wu Q, Bai Z, Si J, Zuo X, Shi N, Li J, Chu X. Impact of glycemic control status on patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. BMC Cardiovasc Disord 2020; 20:36. [PMID: 32000678 PMCID: PMC6993353 DOI: 10.1186/s12872-020-01339-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023] Open
Abstract
Background The combined effects of diabetes mellitus (DM), admission plasma glucose (APG), and glycated hemoglobin (HbA1c) levels on predicting long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) are unknown. Therefore, we evaluated their combined effects on long-term clinical outcomes in STEMI patients treated with pPCI. Methods In total, 350 consecutive patients with STEMI undergoing pPCI were enrolled. Patients were divided into 3 groups according to DM history and APG and HbA1c levels. The cumulative rates of 24-month all-cause deaths and major adverse cardiac and cerebrovascular events (MACCEs) were calculated. Results Both the incidence of all-cause deaths and cumulative rates of MACCEs were significantly the lowest in patients without a DM history and admission HbA1c level < 6.5%. DM patients with poor glycemic control or stress hyperglycemia on admission experienced the highest rates of all-cause deaths, MACCEs, and cardiac deaths. Admission HbA1c levels, Triglyceride (TG) levels, hemoglobin levels, DM history, and admission Killip class > 1 correlated with 24-month all-cause death; HbA1c levels on admission, DM history, APG levels, history of stroke, history of coronary heart disease, and TG levels on admission were significantly associated with MACCEs through the 24-month follow-up. The predictive effects of combining DM and APG and HbA1c levels were such that for STEMI patients undergoing pPCI, DM patients with poor glycemic control or with stress hyperglycemia on admission had worse prognosis than other patients. Conclusion Strict control of glycemic status may improve the survival of patients who have both DM and coronary heart diseases.
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Affiliation(s)
- Yan Li
- Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China
| | - Xiaowen Li
- Emergency Department, Aerospace Center Hospital, Beijing, China
| | - Yinhua Zhang
- Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China
| | - Leimin Zhang
- Department of internal medicine, Qinghe Substation Hospital of Beijing Municipal Administration of Prisons, Beijing, China
| | - Qingqing Wu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhaorun Bai
- Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China
| | - Jin Si
- Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China
| | - Xuebing Zuo
- Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China
| | - Ning Shi
- Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China.
| | - Xi Chu
- Health Management Center, Xuanwu hospital, Capital Medical University, Beijing, China.
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Diabetes Mellitus and Acute Myocardial Infarction: Impact on Short and Long-Term Mortality. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:153-169. [PMID: 32020518 DOI: 10.1007/5584_2020_481] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus (DM) is an important risk factor for acute myocardial infarction (AMI) and a frequent co-morbidity in patients hospitalized with AMI, being present in about 30% of cases. Although current treatment of AMI has considerably improved survival in both patients with and without DM, the presence of DM still doubles the case fatality rate during both the acute phase of AMI and at long-term follow-up. This higher mortality risk of DM patients strongly indicates a particular need for better treatment options in these patients and suggests that intensive medical treatment, prolonged surveillance, and stringent control of other risk factors should be carefully pursued and maintained for as long as possible in them.In this review, we will focus on the close association between DM and in-hospital and long-term mortality in AMI patients. We will also aim at providing current evidence on the mechanisms underlying this association and on emerging therapeutic strategies, which may reduce the traditional mortality gap that still differentiates AMI patients with DM from those without.
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Bruginski D, Précoma DB, Sabbag A, Olandowski M. Impact of Glycemic Variability and Hypoglycemia on the Mortality and Length of Hospital Stay among Elderly Patients in Brazil. Curr Diabetes Rev 2020; 16:171-180. [PMID: 31250764 DOI: 10.2174/1573399815999190619141622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/06/2019] [Accepted: 05/16/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Glycemic variability (GV) is an alternative diabetes-related parameter that has been associated with mortality and longer hospitalization periods. There is no ideal method for calculating GV. In this study, we used standard deviation and coefficient of variation due to their suitability for this sample and ease of use in daily clinical practice. OBJECTIVE This study aimed to investigate the association between GV, hypoglycemia, and the 90-day mortality and length of hospital stay (LOS) among non-critically ill hospitalized elderly patients. METHODS The medical records of 2,237 elderly patients admitted to the Zilda Arns Elderly Hospital over a 2.5-year period were reviewed. Hypoglycemia was defined as a glucose level <70 mg/dL (hypoglycemia alert value) and represented by the proportion of days in which the patient presented with this condition relative to the LOS. The Charlson comorbidity index was used to evaluate prognosis. Data were analyzed using multiple linear and logistic multivariate regression analyses. RESULTS Adjusted analysis of 687 patients (305 men [44.4%] and 382 women [55.6%], mean age of 77.86±9.25 years) revealed that GV was associated with a longer LOS (p=0.048). Mortality was associated with hypoglycemia (p=0.005) and mean patient-day blood glucose level (p=0.036). Variables such as age (p<0.001), Charlson score (p<0.001), enteral diet (p<0.001), and corticosteroid use (p=0.007) were also independently associated with 90-day mortality. CONCLUSION Increased GV during hospitalization is independently associated with a longer LOS and hypoglycemia in non-critically ill elderly patients, while the mean patient-day blood glucose is associated with increased mortality.
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Affiliation(s)
- Danielle Bruginski
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | | | - Ary Sabbag
- Biostatistics Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Marcia Olandowski
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
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Wang J, Luo X, Jin X, Lv M, Li X, Dou J, Zeng J, An P, Chen Y, Chen K, Mu Y. Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of Coronary Artery Disease Surgical Treatment in Patients with Diabetes Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis. J Diabetes Res 2020; 2020:3547491. [PMID: 32190696 PMCID: PMC7066407 DOI: 10.1155/2020/3547491] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/28/2020] [Indexed: 11/17/2022] Open
Abstract
AIMS To investigate the effect of preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgery in diabetic and nondiabetic patients. METHODS AND RESULTS The MEDLINE (via PubMed), Cochrane Library, Web of Science, Embase, Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) databases were used to search the effects of different preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgical treatment in diabetic and nondiabetic patients from inception to December 2018. Two review authors worked in an independent and duplicate manner to select eligible studies, extract data, and assess the risk of bias of the included studies. We used a meta-analysis to synthesize data and analyze subgroups, sensitivity, and publication bias as well as the GRADE methodology if appropriate. The literature search retrieved 886 records initially, and 23 cohort studies were included in the meta-analysis. In this meta-analysis, we found that there was a reduced incidence of surgical site infections (OR = 2.94, 95% CI 2.18-3.98), renal failure events (OR = 1.63, 95% CI 1.13-2.33), and myocardial infarction events (OR = 1.69, 95% CI 1.16-2.47), as well as a shortened hospital stay (MD = 1.08, 95% CI 0.46-1.71), in diabetic patients after coronary artery disease surgical treatment with lower preoperative HbA1c levels. For nondiabetic patients, a higher preoperative HbA1c level resulted in an increase in the incidence of mortality (OR = 2.23, 95% CI 1.01-4.90) and renal failure (OR = 2.33, 95% CI 1.32-4.12). No significant difference was found between higher and lower preoperative HbA1c levels in the incidence of mortality (OR = 1.06, 95% CI 0.88-1.26), stroke (OR = 1.49, 95% CI 0.94-2.37), or atrial fibrillation (OR = 0.94, 95% CI 0.67-1.33); the length of ICU stay (MD = 0.20, 95% CI -0.14-0.55); or sepsis incidence (OR = 2.49, 95% CI 0.99-6.25) for diabetic patients or for myocardial infarction events (OR = 1.32, 95% CI 0.27-6.31) or atrial fibrillation events (OR = 0.99, 95% CI 0.74-1.33) for nondiabetic patients. The certainty of evidence was judged to be moderate or low. CONCLUSION This meta-analysis showed that higher preoperative HbA1c levels may potentially increase the risk of surgical site infections, renal failure, and myocardial infarction and reduce the length of hospital stay in diabetic subjects after coronary artery disease surgical treatment and increase the risk of mortality and renal failure in nondiabetic patients. However, there was great inconsistency in defining higher preoperative HbA1c levels in the studies included; we still need high-quality RCTs with a sufficiently large sample size to further investigate this issue in the future. This trial is registered with CRD42019121531.
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Affiliation(s)
- Jinjing Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Departmentof Endocrinology, South Hospital District, Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou 730000, China
- Evidence-Based Medicine Center, Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China
| | - Xinye Jin
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Meng Lv
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Xueqiong Li
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Department of Gerontology, First Affiliated Hospital of Kunming Medical University, Kunming 650031, China
| | - Jingtao Dou
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jing Zeng
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
- Departmentof Endocrinology, South Hospital District, Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Ping An
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China
| | - Kang Chen
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
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Chai TY, McLean M, Wong VW, Cheung NW. Glycaemic variability is associated with adverse cardiovascular outcomes in patients hospitalised with an acute myocardial infarction. J Clin Transl Endocrinol 2019; 18:100203. [PMID: 31440454 PMCID: PMC6699552 DOI: 10.1016/j.jcte.2019.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022] Open
Abstract
Unlike admission hyperglycaemia, there is significant controversy surrounding whether acute glycaemic variability is associated with major adverse cardiovascular events (MACE) in patients immediately after an acute myocardial infarction (AMI). We conducted a retrospective post-hoc analysis in an AMI population and determined fluctuating glycaemia is associated with a higher risk of 3–month MACE.
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Gao S, Liu Q, Ding X, Chen H, Zhao X, Li H. Predictive Value of the Acute-to-Chronic Glycemic Ratio for In-Hospital Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Angiology 2019; 71:38-47. [PMID: 31554413 PMCID: PMC6886151 DOI: 10.1177/0003319719875632] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study investigated whether a novel index of stress hyperglycemia might have a better prognostic value compared to admission glycemia alone in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The acute-to-chronic glycemic ratio was expressed as admission blood glucose (ABG) devided by the estimated average glucose (eAG), and eAG was derived from the glycated hemoglobin (HbA1c). A total of 1300 consecutive patients with STEMI treated with PCI were included. Baseline data and outcomes were analyzed. The study end point was a composite of in-hospital all-cause death, cardiogenic shock, and acute pulmonary edema. Accuracy was defined with area under the curve (AUC) by a receiver–operating characteristic (ROC) curve analysis. After multivariate adjustment, both ABG/eAG and ABG were closely associated with an increased risk of the composite end point in nondiabetic patients. However, only ABG/eAG (odds ratio = 2.45, 95% confidence interval: 1.24-4.82, P = .010), instead of ABG, was associated with the outcomes in diabetic patients. Compared to ABG, ABG/eAG had an equivalent predictive value in nondiabetic patients but a superior discriminatory ability in diabetic patients (AUC improved from 0.52-0.63, P < .001). Taken together, ABG/eAG provides more significant in-hospital prognostic information than ABG in diabetic patients with STEMI after PCI.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qingbo Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xueqiao Zhao
- Division of Cardiology, Clinical Atherosclerosis Research Lab, University of Washington, Seattle, WA, USA
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Disease, Beijing, China
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Sun YF, Song Y, Liu CS, Geng JL. Correlation between the glucose level and the development of acute pancreatitis. Saudi J Biol Sci 2019; 26:427-430. [PMID: 31485188 PMCID: PMC6717129 DOI: 10.1016/j.sjbs.2018.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 01/04/2023] Open
Abstract
Objective To investigate the correlation between the level of glucose in serum and the development of acute pancreatitis (AP). Methods Data of 153 AP cases were collected, in which there were 130 patients with mild AP (MAP), 4 with moderate-severe AP (MSAP) and 19 with severe AP (SAP). At the time of admission, following indexes of patients were recorded: glucose, APACHE II score, TNF-α and C-reaction protein (CRP). Results At the time of admission, the levels of glucose in serum and APACHE II scores in the MSAP and SAP groups were significantly higher than those in the MAP group, but after treatment, the level of glucose in serum was recovered in 95.8% of the patients in the MAP group, while this digit in the SAP group remained to be 68.4%; in the SAP group, the levels of TNF-α and CRP in patients with sustained hypertension were significantly higher than those with non-persistent hypertension; in terms of the length of stay in hospital, the SAP group was shorter than that in the non-treatment group, and the difference had statistical significance (p < 0.05). Moreover, we found that the level of glucose in serum was positively correlated with the APACHE II scores, TNF-α and CRP. Conclusion Glucose level in serum can be used as one of the indicators for evaluating the severity and development of AP in clinical practice.
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Affiliation(s)
- Yun-Fu Sun
- Department of Hepatobiliary Surgery, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai 264200, China
| | - Yu Song
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai 264200, China
| | - Chang-Sheng Liu
- The Second Department of General Surgery, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai 264200, China
| | - Jian-Li Geng
- Department of Hepatobiliary Surgery, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai 264200, China
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Avogaro A, Bonora E, Consoli A, Del Prato S, Genovese S, Giorgino F. Glucose-lowering therapy and cardiovascular outcomes in patients with type 2 diabetes mellitus and acute coronary syndrome. Diab Vasc Dis Res 2019; 16:399-414. [PMID: 31044622 DOI: 10.1177/1479164119845612] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes is a common comorbidity in patients hospitalized for an acute coronary syndrome event, and prevalence is increasing. Among patients hospitalized with acute myocardial infarction, diabetes can be an independent predictor of mortality and new cardiovascular events; both short- and long-term outcomes are worse for patients with diabetes relative to those without, and undiagnosed diabetes is associated with greater mortality. The impact of glycemic control on cardiovascular outcomes and the best approach to treat hyperglycemia upon hospital admission for acute coronary syndrome in patients with or without known diabetes remain open questions. This review assesses available evidence for hyperglycemia management at the time of admission for acute coronary syndrome and, thereafter, finds that (1) admission plasma glucose plays a role in predicting adverse events, especially in patients with unknown diabetes; (2) glycated haemoglobin is a likely predictor of events in patients with unknown diabetes; and (3) hypoglycemia at the time of acute myocardial infarction hospital admission is an important predictor for mortality in patients with and without diabetes. Whether glucose-targeted insulin and glucose infusion have advantages over glucose-insulin-potassium infusion remains controversial. Evidence for the effect of novel glucose-lowering agents used at the time of an acute cardiovascular event is limited and requires more dedicated studies.
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Affiliation(s)
- Angelo Avogaro
- 1 Unit of Metabolic Diseases, Department of Medicine, University of Padova, Padova, Italy
| | - Enzo Bonora
- 2 Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | | | - Stefano Del Prato
- 4 Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy
| | - Stefano Genovese
- 5 Diabetes Endocrine and Metabolic Diseases Unit, Centro Cardiologico Monzino, Milan, Italy
| | - Francesco Giorgino
- 6 Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
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Chittineni C, Driver BE, Halverson M, Cole JB, Prekker ME, Pandey V, Lai T, Harrington J, Zhao S, Klein LR. Incidence and Causes of Iatrogenic Hypoglycemia in the Emergency Department. West J Emerg Med 2019; 20:833-837. [PMID: 31539342 PMCID: PMC6754198 DOI: 10.5811/westjem.2019.7.42996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/14/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction Hypoglycemia is frequently encountered in the emergency department (ED) and has potential for serious morbidity. The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes. Methods We included adult patients with a chief complaint or ED diagnosis of hypoglycemia, or an ED glucose value of ≤70 milligrams per deciliter (mg/dL) between 2009–2014. Two independent abstractors each reviewed charts of patients with an initial glucose ≤ 50 mg/dL, or initial glucose ≥ 70 mg/dL with a subsequent glucose ≤ 50 mg/dL, to determine if the hypoglycemia was caused by iatrogenesis. The data analysis was descriptive. Results We reviewed the charts of 591 patients meeting inclusion criteria. Of these 591 patients, 99 (17%; 95% confidence interval, 14–20%) were classified as iatrogenic. Of these 99 patients, 61 (61%) cases of hypoglycemia were caused by insulin administration and 38 (38%) were caused by unrecognized malnutrition. Of the 61 patients with iatrogenic hypoglycemia after ED insulin administration, 45 and 15 patients received insulin for hyperkalemia and uncomplicated hyperglycemia, respectively. One patient received insulin for diabetic ketoacidosis. Conclusion In ED patients with hypoglycemia, iatrogenic causes are relatively common. The most frequent cause was insulin administration for hyperkalemia and uncomplicated hyperglycemia. Additionally, patients at risk of hypoglycemia in the absence of insulin, including those with alcohol intoxication or poor nutritional status, should be monitored closely in the ED.
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Affiliation(s)
- Chaitanya Chittineni
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota.,University of Minnesota School of Medicine, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Brian E Driver
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Matthew Halverson
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Jon B Cole
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Matthew E Prekker
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Vidhu Pandey
- University of Minnesota School of Medicine, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Tarissa Lai
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Justin Harrington
- Mercy Medical Center-North Iowa, Department of Emergency Medicine, Mason City, Iowa
| | - Sean Zhao
- Aventura Hospital and Medical Center, Department of Emergency Medicine, Miami, Florida
| | - Lauren R Klein
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
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Koracevic GP. Should Target Glycemic Range Be Exactly the Same for Patients With Acute Myocardial Infarction Versus Without Diabetes? J Emerg Med 2019; 57:250-253. [DOI: 10.1016/j.jemermed.2018.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
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49
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Serum potassium and glucose levels, and mortality in acute myocardial infarction; fact or myth? Int J Cardiol 2019; 287:50-52. [DOI: 10.1016/j.ijcard.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 11/18/2022]
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50
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Gerbaud E, Darier R, Montaudon M, Beauvieux MC, Coffin-Boutreux C, Coste P, Douard H, Ouattara A, Catargi B. Glycemic Variability Is a Powerful Independent Predictive Factor of Midterm Major Adverse Cardiac Events in Patients With Diabetes With Acute Coronary Syndrome. Diabetes Care 2019; 42:674-681. [PMID: 30728222 DOI: 10.2337/dc18-2047] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Acute glucose fluctuations are associated with hypoglycemia and are emerging risk factors for cardiovascular outcomes. However, the relationship between glycemic variability (GV) and the occurrence of midterm major cardiovascular events (MACE) in patients with diabetes remains unclear. This study investigated the prognostic value of GV in patients with diabetes and acute coronary syndrome (ACS). RESEARCH DESIGN AND METHODS This study included consecutive patients with diabetes and ACS between January 2015 and November 2016. GV was assessed using SD during initial hospitalization. MACE, including new-onset myocardial infarction, acute heart failure, and cardiac death, were recorded. The predictive effects of GV on patient outcomes were analyzed with respect to baseline characteristics and cardiac status. RESULTS A total of 327 patients with diabetes and ACS were enrolled. MACE occurred in 89 patients (27.2%) during a mean follow-up of 16.9 months. During follow-up, 24 patients (7.3%) died of cardiac causes, 35 (10.7%) had new-onset myocardial infarction, and 30 (9.2%) were hospitalized for acute heart failure. Multivariable logistic regression analysis showed that GV >2.70 mmol/L, a Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score >34, and reduced left ventricular ejection fraction of <40% were independent predictors of MACE, with odds ratios (ORs) of 2.21 (95% CI 1.64-2.98; P < 0.001), 1.88 (1.26-2.82; P = 0.002), and 1.71 (1.14-2.54; P = 0.009), respectively, whereas a Global Registry of Acute Coronary Events (GRACE) risk score >140 was not (OR 1.07 [0.77-1.49]; P = 0.69). CONCLUSIONS A GV cutoff value of >2.70 mmol/L was the strongest independent predictive factor for midterm MACE in patients with diabetes and ACS.
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Affiliation(s)
- Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France.,Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | - Romain Darier
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
| | - Michel Montaudon
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | | | | | - Pierre Coste
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France.,Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | - Hervé Douard
- Department of Cardiovascular Medicine, Hôpital Cardiologique du Haut Lévêque, Bordeaux University, Pessac, France
| | - Alexandre Ouattara
- Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux University, Pessac, France.,Biology of Cardiovascular Diseases Centre, U1034, Bordeaux University, Pessac, France
| | - Bogdan Catargi
- Endocrinology-Metabolic Diseases, Hôpital Saint-André, Bordeaux University, Bordeaux, France
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