Hyperglycaemia in acute coronary syndromes in diabetics and non-diabetics
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 12
Abstract
Elevated glucose blood concentration in diabetic patients and stress hyperglyceamia in non-diabetic patients are associated with worse outcome in acute coronary syndrome. Stress hyperglyceamia is associated with an increased mortality, heart failure and cardiogenic shock in patients with acute coronary syndrome without diabetes mellitus. Several studies have shown positive correlation between admission hyperglyceamia, elevated fasting glucose level or hyperglyceamia during first 24 hours of acute myocardial infarction and cardiovascular events. It is still not known whether hyperglyceamia is a marker of severity of underlying diseases or is a cause of poor outcome. Acute hyperglyceamia is caused by hormonal changes and adrenergic activation. Hyperglyceamia has been shown to have negative effects on the endothelial cells, leukocytes and platelets. The target glucose concentration during an acute coronary syndrome in diabetic and non-diabetic patients are not clearly defined. The European Society of Cardiology and the Polish Society of Diabetology recommend strict glucose control but clinical trials of intensive insulin treatment in patients with acute myocardial infarction have shown inconsistent results and have had numerous limitations. Insulin treatment is recommended during the first 24 hours of hospitalization. Implementation of treatment in order to achieve and maintain blood glucose level between 100 and 180 mg/dl during next days is associated with vascular complications and the increased daily insulin requirement.
Authors and Affiliations
Małgorzata Sikora-Frąc
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