Endocrine Abstracts

Background: Dysglycemia is independently associated with increased risk of death in critically ill adults. The aim of this study was to analyze the differences in glycemic control between the diabetic and non- diabetic patients underwent acute myocardial infarction (AMI).

Materials and methods: Retrospective descriptive study of patients with acute myocardial infarction (AMI) admitted to the intensive care unit (ICU) from January to June 2016, including blood parameters, glycemic treatment, mortality and length of intra hospital stay.

Results: 267 individuals with AMI were admitted to the ICUduring the study period. 27.3% of them had a previously diagnosed type 2 diabetes (T2DM) and 10.8% had newly diagnosed diabetes. 50.94% were women and the mean age was 72.36 (s.d. 10.49)/ 69.35 (s.d. 11.9) in diabetics/ non-diabetics. Blood glucose on admission was measured in 79.45% T2DM patients/48.45% patients without T2DM in anamnesis. HbA1c was determined only in 28.8% T2DM patients (mean HbA1c was 6.9%, s.d. 0.93). In diabetic patients the mean glucose level at admission/during ICU stay – 12.41 mmol/l (s.d. 7.33 mmol/l) /9.94 mmol/l (s.d. 4.57 mmol/l). In 23.3% of diabetic patients more than 80% of blood glucose values fell in the target range from 3.9 to 10 mmol/l. The most common treatment used was sliding-scale insulin 36.9%, sliding-scale + IV insulin 12.3% and IV insulin only in 5.6%.

In non-diabetic patients the mean glucose level at admission/ during ICU stay was 6.72 mmol/l (s.d. 2.27 mmol/l)/6.5 mmol/l (s.d. 1.99 mmol/l). About 30 percent of patients without diabetes develop stress hyperglycemia (SH), 19% of them were treated with insulin (sliding-scale). In only 6.45% of patients with SH achieved 80% of blood glucose values in target range from 3.9 to 7.8 mmol/l. Studies showed that time in targeted blood glucose range from 3.9 to 7.8 mmol/l >80% is associated with survival in critically ill patients without diabetes.

Regarding outcomes, 11.7% of diabetics died versus 9.1% in non-diabetics (P < 0.05). As to non-diabetic patients in normoglycemic ones intrahospital mortality consists 5.5% vs 35.5% in patients with SH (P < 0.005).

Conclusion: hyperglycemic patients (both with T2DM and SH) have poorer outcomes after acute myocardial infarction. Our study reviled the insufficient quality of glycemic control in hyperglycemic patients with AMIin ICU. The reason for the poor glycemic control may be the widespread use of sliding scale insulin therapy instead of IV insulin, which is recommended in most international protocols.