Consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome.
The Diabetes and Cardiovascular Disease study group of the Société francophone du diabète (SFD, French Society of Diabetes) in collaboration with the Société française de cardiologie (SFC, French Society of Cardiology) have devised a consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome (ACS); in particular, it includes the different phases of ACS [the intensive care unit (ICU) period, the post-ICU period and the short-term follow-up period after discharge, including cardiac rehabilitation] and also embraces all of the various diagnostic and therapeutic issues with a view to optimizing the collaboration between cardiologists and diabetologists. As regards diagnosis, subjects with HbA(1c) greater or equal to 6.5% on admission may be considered diabetic while, in those with no known diabetes and HbA(1c) less than 6.5%, it is recommended that an OGTT be performed 7 to 28 days after ACS. During hospitalization in the ICU, continuous insulin treatment should be initiated in all patients when admission blood glucose levels are greater or equal to 180 mg/dL (10.0 mmol/L) and, in those with previously known diabetes, when preprandial glucose levels are greater or equal to 140 mg/dL (7.77 mmol/L) during follow-up. The recommended blood glucose target is 140-180 mg/dL (7.7-10 mmol/L) for most patients. Following the ICU period, insulin treatment is not mandatory for every patient, and other antidiabetic treatments may be considered, with the choice of optimal treatment depending on the metabolic profile of the patient. Patients should be referred to a diabetologist before discharge from hospital in cases of unknown diabetes diagnosed during ACS hospitalization, of HbA(1c) greater or equal to 8% at the time of admission, or newly introduced insulin therapy or severe/repeated hypoglycaemia. Referral to a diabetologist after hospital discharge is recommended if diabetes is diagnosed by the OGTT, or during cardiac rehabilitation in cases of uncontrolled diabetes (HbA(1c) ≥ 8%) or severe/repeated hypoglycaemia.
Service d’endocrinologie, diabétologie et maladies métaboliques, hôpital du Bocage, CHU, 21000 Dijon, France. bruno.verges@chu-dijon.fr
B
B
Vergès
A
A
Avignon
F
F
Bonnet
B
B
Catargi
S
S
Cattan
E
E
Cosson
G
G
Ducrocq
M
M
Elbaz
A
A
Fredenrich
P
P
Gourdy
P
P
Henry
O
O
Lairez
A M
AM
Leguerrier
C
C
Monpère
P
P
Moulin
B
B
Vergès-Patois
R
R
Roussel
G
G
Steg
P
P
Valensi
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002309:Cardiology / Q000592:standards*; D003422:Critical Care / Q000592:standards; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004032:Diet / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards; D005951:Glucose Tolerance Test / Q000592:standards; D006442:Glycated Hemoglobin / Q000378:metabolism; D006334:Heart Function Tests / Q000592:standards; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage; D010348:Patient Care Team / Q000592:standards; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000592:standards; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human