Inpatient diabetes: review of data from the cardiac care unit.
OBJECTIVE
To review prospective and retrospective studies in an effort to assess the effect of glucose control on outcomes in critically ill populations.


METHODS
Results from recent prospective and retrospective studies are presented and analyzed in detail, with an emphasis on patients with myocardial infarction.


RESULTS
Retrospective observations show that, with the routine use of percutaneous coronary interventions, hyperglycemia continues to be a risk factor for mortality. In 2 prospective studies using glucose-insulin-potassium infusion, glucose levels did not reach target, and the results of both trials were negative with regard to the primary endpoint, mortality. However, progressive hyperglycemia was a risk factor for death in both prospective studies. It is an interesting paradox that diabetes actually may be protective for myocardial infarction. Although the reasons for this are not clear, one study showed that patients with diabetes were more likely to receive insulin for any given blood glucose level.


CONCLUSIONS
A study using variable-rate intravenous insulin infusion should be commissioned. In the meantime, clinicians should strive to achieve the best-possible glucose control in all patients with acute myocardial infarction and hyperglycemia. While we improve our understanding of the basic roles of glucose and insulin in modulating inflammation, we must aggressively treat hyperglycemia to the national goals for this population, which would substantially improve outcomes.
Hirsch
Irl B
IB
Department of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, Washington, USA.
D001786:Blood Glucose / Q000032:analysis; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000150:complications; D015996:Survival Rate
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin