Observational Study
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World J Diabetes. Aug 15, 2014; 5(4): 562-568
Published online Aug 15, 2014. doi: 10.4239/wjd.v5.i4.562
Conventional insulin vs insulin infusion therapy in acute coronary syndrome diabetic patients
Caterina Arvia, Valeria Siciliano, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Sabrina Molinaro, Giorgio Iervasi
Caterina Arvia, Kyriazoula Chatzianagnostou, Gillian Laws, Alfredo Quinones Galvan, Chiara Mammini, Sergio Berti, Giorgio Iervasi, Fondazione CNR/Regione Toscana G Monasterio, 56124 Pisa, Italy
Valeria Siciliano, Sabrina Molinaro, Giorgio Iervasi, CNR Institute of Clinical Physiology, 56124 Pisa, Italy
Author contributions: Arvia C, Chatzianagnostou K, Laws G, Quinones Galvan A, Mammini C and Berti S performed the majority of clinical experiments and contributed to design of the study; Arvia C and Chatzianagnostou K were also involved in the analysis and interpretation of data; Arvia C and Iervasi G contributed to the conception of the study and drafting the article; Siciliano V and Molinaro S contributed to the conception and design of the study and to the interpretation of results.
Supported by Fondazione CNR/Regione Toscana G Monasterio
Correspondence to: Giorgio Iervasi, MD, CNR Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy. iervasi@ifc.cnr.it
Telephone: +39-050-3152017 Fax: +39-050-3152651
Received: December 23, 2013
Revised: January 23, 2014
Accepted: May 16, 2014
Published online: August 15, 2014
Abstract

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 activity.

METHODS: 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 daily δ glucose (mean of daily difference between maximum and minimum glucose), and the coefficient of variation (CV) of glucose, expressed as percent glucose (SD)/glucose (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, respectively. When compared with patients submitted to standard therapy, insulin-infused patients showed both increased first 24-h (median 6.9 mmol/L vs 5.7 mmol/L P < 0.045) and overall hospitalization δ glucose (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 therapy. HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.

CONCLUSION: 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 treatment

Keywords: Glycaemic management, Intensive insulin therapy, Conventional insulin treatment, Acute coronay syndrome, Glucose variability

Core tip: In type 2 diabetic patients hospitalized for acute coronary syndrome no real benefit in terms of reduced glucose variability is observed by intensively managing blood glucose through insulin infusion therapy in respect to conventional insulin treatment