Glucose-Lowering Algorithm Safe in Coronary Care Unit

With target serum glucose 90 to 117 mg/dL, no difference in hypoglycemia symptoms, outcomes

FRIDAY, Jan. 6 (HealthDay News) -- In coronary care unit (CCU) patients, a paper-based glucose-lowering algorithm with target serum glucose levels of 5.0 to 6.5 mmol/L (90 to 117 mg/dL) can be safely implemented, but further studies are needed to assess cardiovascular outcomes, according to research published in the January issue of Diabetes Care.

Kara A. Nerenberg, M.D., M.S.C., of McMaster University in Hamilton, Canada, and colleagues analyzed mean glucose levels at 24 hours in 287 coronary care unit (CCU) patients with an acute ST-segment elevation myocardial infarction and a capillary glucose level of ≥8.0 mmol/L. These patients were randomly assigned glucose management with either intravenous glulisine insulin using a paper-based glucose-lowering algorithm, followed by 30 days of once-daily subcutaneous glargine injections, or with standard methods, in which physicians could choose to treat the patient with insulin therapy for high serum glucose levels. Patients were followed for 90 days to assess clinical outcomes.

According to the researchers, the mean glucose level at 24 hours was lower in the insulin group (6.53 mmol/L) than in the standard group (7.94 mmol/L). Glucose level differences were maintained at 72 hours and at 30 days. Asymptomatic hypoglycemia was higher in the insulin group than the standard group (22.7 versus 4.4 percent), with no differences in symptomatic hypoglycemia or clinical outcomes between the groups.

"A paper-based insulin algorithm targeting glucose levels of 5.0 to 6.5 mmol/L (90 to 117 mg/dL) can be feasibly implemented in the CCU. A cardiovascular outcomes trial using this approach can determine whether targeted glucose lowering improves patient outcomes," the authors write.

The trial was funded by sanofi-aventis, the manufacturer of glulisine and glargine; several authors disclosed financial relationships with sanofi-aventis.

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