Interv Akut Kardiol. 2011;10(2):67-71

Glycaemic control in patients with acute myocardial infarction

Jan Šoupal, Martin Prázný

3. interní klinika VFN a 1. LF UK, Praha

Numerous observational studies indicate that patients with diabetes are at a higher risk of developing cardiovascular diseases including

myocardial infarction. In the long term, tight diabetes control leads to a reduced risk of developing cardiovascular complications and

diabetic patients clearly benefit from it. However, our knowledge of the benefits of tight glycaemic control in patients with acute myocardial

infarction remains limited even though these patients are frequently found to have stress hyperglycaemia. Some of the recent

studies have shown that hyperglycaemia in the critically ill is associated with a higher morbidity and mortality and that, for instance in

cardiac surgery patients, intensive insulin therapy results in reduced hyperglycaemia in the postoperative period. However, it is still not

entirely clear whether this can also be the case in patients hospitalized for acute myocardial infarction. Limiting factors for the treatment

of hyperglycaemia in patients with acute myocardial infarction currently include the lacking knowledge of the optimal target range for

glycaemic control and the lack of a safe dosing algorithm for insulin. A major obstacle in achieving tight glycaemic control is the high

risk of hypoglycaemia. Some studies performed in critically ill patients suggest that the presence of hypoglycaemia may worsen the

prognosis of patients. Therefore, it is a priority to create a safe administration schedule for intensive glycaemic control, the so-called

insulin protocol. The trend so far has been towards a fully automatic closed-loop system which would enable automatic dosing of insulin

based on the current level of glycaemia and with a minimal risk of developing hypoglycaemia.

Keywords: hyperglycaemia, acute myocardial infarction, critically ill patient

Published: April 14, 2011  Show citation