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Conventional insulin vs insulin infusion therapy in acute coronary syndrome diabetic patients

World Journal of Diabetes 2014年第4期5卷 562-568页

作者： Caterina Arvia Valeria Siciliano Kyriazoula Chatzianagnostou Gillian Laws Alfredo Quinones Galvan Chiara Mammini Sergio Berti sabrina molinaro Giorgio Iervasi Fondazione CNR/Regione Toscana G Monaste-rio 56124 Pisa Italy CNR In-stitute of Clinical Physiology 56124 Pisa Italy

AIM: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 ***: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 dailyδglucose(mean of daily difference between maximum and minimum glucose),and the coefficient of variation(CV)of glucose,expressed as percent glucose(SD)/glu-cose(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,*** compared with patients submitted to standard therapy,insulin-infused patients showed both increased first 24-h(median 6.9 mmol/L vs 5.7mmol/L P<0.045)and overall hospitalizationδglucose(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 ***1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of ***: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

关键词： Glycaemic management Intensive insulin therapy Conventional insulin treatment Acute coronay syndrome Glucose variability

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