title: Conventional insulin vs insulin infusion therapy in acute coronary syndrome diabetic patients.
abstract: OBJECTIVE
  To evaluate the impact on glucose variability (GLUCV) of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.
  
  
  METHODS
  We enrolled 44 type 2 diabetic patients (n = 32 males; n = 12 females) with acute coronary syndrome (ACS) and randomy assigned to standard a subcutaneous insulin treatment (n = 23) or a nurse-implemented continuous intravenous insulin infusion protocol (n = 21). We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis, i.e., glucose standard deviation (SD), the mean daily δ glucose (mean of daily difference between maximum and minimum glucose), and the coefficient of variation (CV) of glucose, expressed as percent glucose (SD)/glucose (mean).
  
  
  RESULTS
  At the admission, first fasting blood glucose, pharmacological treatments (insulin and/or anti-diabetic drugs) prior to entering the study and basal glycated hemoglobin (HbA1c) were observed in the two groups treated with subcutaneous or intravenous insulin infusion, respectively. When compared with patients submitted to standard therapy, insulin-infused patients showed both increased first 24-h (median 6.9 mmol/L vs 5.7 mmol/L P < 0.045) and overall hospitalization δ glucose (median 10.9 mmol/L vs 9.3 mmol/L, P < 0.028), with a tendency to a significant increase in first 24-h glycaemic CV (23.1% vs 19.6%, P < 0.053). Severe hypoglycaemia was rare (14.3%), and it was observed only in 3 patients receiving insulin infusion therapy. HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.
  
  
  CONCLUSIONS
  Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin treatment.
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Arvia
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Siciliano
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Kyriazoula
authors.initials: K
authors.lastname: Chatzianagnostou
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Gillian
authors.initials: G
authors.lastname: Laws
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones Galvan
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mammini
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Molinaro
authors.affiliation: Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iervasi
keywords: Acute coronay syndrome; Conventional insulin treatment; Glucose variability; Glycaemic management; Intensive insulin therapy