Management of diabetes and hyperglycaemia during myocardial infarction: review of the literature.
For many years now, research has firmly demonstrated the increased mortality in patients with diabetes following myocardial infarction (MI), a prognosis which has persisted despite major advances in acute coronary care. Research has also shown higher than usual mortality rates in patients without known diabetes presenting with hyperglycaemia during MI. Due to a lack of research evidence, little has been established about how best to manage glycaemic control in these patients during the acute phase of an MI. However, a recent clinical trial has had considerable impact on coronary care practice. It advocates intravenous insulin therapy for all diabetics and patients with hyperglycaemia during acute MI, followed by subcutaneous insulin for three months, regardless of previous treatment. The evidence for mortality benefit is substantial, but the trial has left some questions unanswered. The aim in this literature review is to examine critically the research basis for using insulin during and after MI, and to identify the potential impact of the research on patients and nurses. The author searched the CINAHL and MEDLINE indexes for relevant texts in English from 1975 to 1998, and has recently implemented relevant knowledge from this research into her own work area, a coronary care unit in the north of England.
Walker
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Cardiac Monitoring Unit, Hull Royal Infirmary.
D003325:Coronary Care Units; D003422:Critical Care / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000451:nursing / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000451:nursing / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy / Q000451:nursing / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000150:complications*
D007004:Hypoglycemic Agents; D007328:Insulin