Endocrine Abstracts

Hyperglycaemia is common in patients (~65%) when they are admitted to hospital with ACS. It is recognised to be one of the important prognostic indicators for all-cause mortality in patients who present with ACS, regardless of pre-existing diabetes1. NICE guidelines recommend to keep blood glucose (BG) levels below 11 mmol/l2 and offer all people with hyperglycaemia after ACS (without known diabetes) for HbA1c 3 check before discharge. We were interested to see whether we followed our national guidelines.

Methodology: Retrospective electronic data collection over a period of 5 months. 31 patients who presented with ACS with BG of >11 mmol/l and trend of BG levels monitored.

Results: 93.5% of the patients had pre-existing diabetes with BG ranges 11-20 mmol/l. 6.5% noted with new hyperglycaemia. None of these patients met the target glucose levels of <11 mmol/l whilst in-patients. Subcutaneous Insulin added to their original treatment in21 %, however dose titration not optimised to achieve the required BG target level. 79% there is no changes were made in their usual diabetes control method despite high BS. 41.9% had their HbA1c levels checked prior to hospital discharge.

Conclusion: Hyperglycaemia is common during ACS which should be effectively managed by clinical team to minimise adverse clinical outcome. It is vital to establish “best practice” guidelines within the hospital with appropriate follow up.

References: 1. Angeli F, Reboldi G, Poltronieri C, et al. Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications. Therapeutic Advances in Cardiovascular Disease. Dec 2015:412-424 2. National Institute for Health and Care Excellence. (2020) Acute coronary syndromes. (NICE guideline NG185) 3. Pan W, Lu H, et al. Prognostic value of HbA1c for in-hospital and short-term mortality in patients with acute coronary syndrome: Cardiovasc Diabetol. Dec 2019.