Stress hyperglycemia in acute miocardial infarction: is it associated with increased mortality? A concern of therapeutic behavior too

Authors

  • Guillermo Alzueta Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Juan Carlos Bauchi Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Endocrinology Specialist; Head of the Endocrinology and Diabetes Service Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Darío Rímoli Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Raúl Suárez Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Amílcar Sosa Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Carlos Santillán (h) Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Mirta Linares Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Ricardo Denaro Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Gracieta Zarza Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Adrián Decundo Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Olguita Vera Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Rosa Salazar Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Segundo Guzmán Rodríguez Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Abel Weinmeister Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Rodolfo Dettorre Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Karina Bastone Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Alfredo Caccavo Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Horacio Costa Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina
  • Claudio Daniel González Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos. Department of Pharmacology of the National University of Buenos Aires, Autonomous city of Buenos Aires, Argentina

DOI:

https://doi.org/10.47196/diab.v52i2.117

Keywords:

stress hyperglycemia, accessibility, acute myocardial infarction

Abstract

Introduction: stress hyperglycemia could increase mortality after acute myocardial infarction (AMI).

Objectives: we explored the association between hyperglycemia and mortality after AMI in a retrospective cohort study. We consider the treatment behavior of hyperglycemia too.

Materials and methods: the mortality rate at hospital discharge post AMI was obtained from a sample of 349 patients assisted in 11 hospitals, between May 2000 and April 2001.

Conclusions: mortality was positively associated with sex, age, Killip score, arrhythmia during hospitalization and hyperglycemia upon admission >Qs, and inversely with BP. Among patients with hyperglycemia, mortality was, compared to non-hyperglycemic patients, much higher in non-diabetics compared to diabetics. The effect of hyperglycemia was especially evident in patients admitted with Killip score 2. Approximately one third of hyperglycemic patients did not receive treatment for it. 90% of the treated patients received insulin and only 20% intravenously. The glycemic values ​​taken into account to start treatment were 50% higher than the value considered in our study as hyperglycemia. The therapeutic approach focused on intervening in the glycemia of known diabetics rather than on its value (82% vs 41.8%) even though the patients were hyperglycemic.

Author Biographies

Guillermo Alzueta, Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina

Specialist in Endocrinology

Juan Carlos Bauchi, Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina

Medical specialist; consultant in Endocrinology, senior in Medical Clinic and Diabetes; Master in Psycho-Immuno-Neuro-Endocrinology; Private practice

Endocrinology Specialist; Head of the Endocrinology and Diabetes Service, Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina

Endocrinology Specialist; Head of the Endocrinology and Diabetes Service

Raúl Suárez, Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina

Hierarchical Specialist in Medical Clinic; Former Head of the HIGA Medical Clinic Service Dr. O. E. Alende

Olguita Vera, Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina

Endocrinologist

Segundo Guzmán Rodríguez, Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos, Argentina

Consulting Specialist in Medical Clinic with Added Certification in Diabetes

Claudio Daniel González, Atlantic Chapter of the Argentine Diabetes Society (ATLANSAD): Balcarce, Punta Alta, Chacabuco, Junín, Mar del Plata, Bahía Blanca, Olavarría, Coronel Suárez, Puerto Madryn, Las Flores, Río Gallegos. Department of Pharmacology of the National University of Buenos Aires, Autonomous city of Buenos Aires, Argentina

Pharmacologist doctor; Advisor on the methodology of the clinical and epidemiological evidence qualification processes

References

Cruikshank N. Coronary thrombosis and myocardial infarction with glycosuria. BMJ: 1931; 1: 618-19.

Yudkin JS, Oswald GA. Hyperglycaemia, diabetes and myocardial infarction. Diabetes Med 1987; 4: 13-18.

Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study). Effects on mortality at 1 year. J Am Coll Cardiol 1995; 26: 57-65.

Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355: 773-778.

Inzucchi SE, Rosenstock J. Counterpoint: inpatient glucose management. Diabetes Care 2005; 28: 976-979.

McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 1995; 9: 1-9.

Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet CG. Impaired leucocytes functions in diabetic patients. Diabet Med 1997; 14: 29-34.

Kersten J, Schmeling T, Orth K, Warltier D. Acute hyperglycemia abolishes ischemic preconditioning in vivo. Am J Physiol 1998; 275: H721-H725.

Ceriello A, Quagliaro L, D’Amico M, Di Filippo C, Marfella R, Nappo F, Berrino L, Rossi F, Giugliano D. Acute hyperglycemia induces nitrotyrosine formation and apoptosis in perfused heart from rat. Diabetes 2002; 51: 1076-1082.

Pulsinelli WA, Waldman S, Rawlinson D, Plum F. Moderate hyperglycemia augments ischemic brain damage: a neuropathologic study in the rat. Neurology 1982; 32: 1239-1246.

Dieuzeide G, Viñes G, Salazar-Sáez E, Arrieta J, Sáenz R, Mayas A, Sosa A, Santillán C, Bauchi JC, Rimoli D, Alzueta G, Bellusci N, Denaro R, Luquesi M, Vera O, Salazar R, González C. Valor pronóstico de la hiperglucemia al ingreso hospitalario en la mortalidad por accidente cerebrovascular. Rev Soc Arg de Diabetes 2005; 39: 3-9.

Williams S, Goldfine A, Timimi F, Ting H, Roddy M, Simonson D, Creager M. Acute hyperglycemia attenuates endothelium-dependent vasodilatation in humans in vivo. Circulation 1998; 97: 1695-1701.

Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias. Lancet 1994; 343: 155-158.

Mjos OD. Effect of free fatty acids on myocardial function and oxygen consumption in intact dogs. J Clin Invest 1971; 50: 1386-89.

Malmberg K, Norhammar A, Wedel H, Ryden L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction. Circulation 1999; 99: 2626-2632.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in critically Ill patients. N Engl J Med 2001; 345:1359-1367.

Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clinic Proceedings August 2004; Vol 79 (8), 992-1000.

Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R. Intensive insulin therapy in the medical ICU. N Engl J Med 2006; 354:449-461.

Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, Rossaint JS, Welte R, Schaefer T, Kern M. Study protocol of the VISEP study. Response of the SepNet study group. Intensive insulin therapy and pentastarch. Resuscitation in severe sepsis. N Engl J Med 2008; 358:125-39.

Preiser JC, Devos P, Ruiz-Santana S, Mélot C, Annane D, Groeneveld J, Iapichino G, Leverve X, Nitenberg G, Singer P, Wernerman J, Joannidis M, Stecher A, Chioléro R. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol Study. Intensive Care Med 2009 Oct; 35(10):1738-48.

The NICE-SUGAR Study Investigators. Intensive vs conventional glucose control in critically Ill patients. N Engl J Med 2009; 360:1283-1297.

Moghissi ES, Korytkowski MT, DiNardo M, et al.; American Association of Clinical Endocrinologists, American Diabetes Association, American Association of Clinical Endocrinologists and American Diabetes Association. Consensus statement on inpatient glycemic control. Diabetes Care 2009;32:1119-1131

Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2011; 154:260-267

Umpierrez GE, Hellman R, Korytkowski MT, et al.; Endocrine Society. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:16-38.

Jacobi J, Bircher N, Krinsley J, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med 2012; 40:3251-3276.

Diabetes Care in the Hospital: Standards of Medical Care in Diabetes 2018 American Diabetes Association. Diabetes Care 2018 Jan; 41(Supplement 1): S144-S151.

Sathya B, Davis R, Taveira T, Whitlatch H, Wu W-C. Intensity of peri-operative glycemic control and postoperative outcomes in patients with diabetes: a meta-analysis. Diabetes Res Clin Pract 2013; 102:8-15.

Umpierrez G, Cardona S, Pasquel F, et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG trial. Diabetes Care 2015; 38:1665-1672.

Moghissi ES, Korytkowski MT, DiNardo M, et al.; American Association of Clinical Endocrinologists, American Diabetes Association, American Association of Clinical Endocrinologists and American Diabetes Association. Consensus statement on inpatient glycemic control. Diabetes Care 2009; 32:1119-1131.

Draznin B, Gilden J, Golden SH, et al.; PRIDE investigators. Pathways to quality inpatient management of hyperglycemia and diabetes: a call to action. Diabetes Care 2013; 36:1807-1814.

Grosembacher LA, Puchulu F, Fretes O, Giunta J, González C, Umpierrez G. Guía de recomendaciones para el manejo de la hiperglucemia en pacientes hospitalizados. Federación Argentina de Sociedades de Endocrinología (FASEN) 2016. Rev Endocrinol Metab 2018; 55(1): 34-40.

Schmeltz LR, DeSantis AJ, Thiyagarajan V, et al. Reduction of surgical mortality and morbidity in diabetic patients undergoing cardiac surgery with a combined intravenous and subcutaneous insulin glucose management strategy. Diabetes Care 2007; 30:823-828.

Shomali ME, Herr DL, Hill PC, Pehlivanova M, Sharretts JM, Magee MF. Conversion from intravenous insulin to subcutaneous insulin after cardiovascular surgery: transition to target study. Diabetes Technol Ther 2011;13:121-126.

Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care 2011; 34:256-261.

Umpierrez GE, et al. Randomized study comparing a basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial. Diabetes Care 2013 Aug; 36(8):2169-74.

Smiley D, et al. Differences in inpatient glycemic control and response to subcutaneous insulin therapy between medicine and surgery patients with type 2 diabetes. J Diabetes Complications 2013 Nov-Dec; 27(6):637-41.

Umpierrez GE, Gianchandani R, Smiley D, et al. Safety and efficacy of sitagliptin therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes: a pilot, randomized, controlled study. Diabetes Care 2013; 36:3430-3435.

Pasquel FJ, et al. Efficacy of sitagliptin for the hospital management of general medicine and surgery patients with type 2 diabetes (Sita-Hospital): a multicentre, prospective, open-label, non-inferiority randomised trial. Lancet Diabetes & Endocrinology 2017; 5 (2) 125-133.

Mendez CE, Umpierrez GE. Pharmacotherapy for hyperglycemia in noncritically ill hospitalized patients. Diabetes Spectr 2014; 27:180-188.

Umpierrez GE, Korytkowski M. Is incretin-based therapy ready for the care of hospitalized patients with type 2 diabetes? Insulin therapy has proven itself and is considered the mainstay of treatment. Diabetes Care 2013; 36:2112-2117.

U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA adds warnings about heart failure risk to labels of type 2 diabetes medicines containing saxagliptin and alogliptin (Internet), 2016. Disponible en: http://www.fda.gov/Drugs/DrugSafety/ucm486096.htm. Acceso: 7 de octubre de 2016.

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Published

2023-01-10

How to Cite

Alzueta, G., Bauchi, J. C., Dieuzeide, G., Rímoli, D., Suárez, R., Sosa, A., Santillán (h), C., Linares, M., Denaro, R., Zarza, G., Decundo, A., Vera, O., Salazar, R., Guzmán Rodríguez, S., Weinmeister, A., Dettorre, R., Bastone, K., Caccavo, A., Costa, H., & González, C. D. (2023). Stress hyperglycemia in acute miocardial infarction: is it associated with increased mortality? A concern of therapeutic behavior too. Journal of the Argentine Society of Diabetes, 52(2 (2018), 37–47. https://doi.org/10.47196/diab.v52i2.117

Issue

Vol. 52 No. 2 (2018): Mayo-Agosto de 2018

Section

Original article

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