Abstract 3529: Feasibility, Effectiveness and Safety of Intensive Glucose Control in Critically Ill Hyperglycemic Patients Hospitalized With Acute Coronary Syndromes
Background: Elevated blood glucose (BG) is associated with higher mortality and complications in patients (pts) hospitalized with AMI. While current ACC/AHA guidelines recommend “normalization” of BG in critically ill AMI pts, experience with implementation of intensive BG control protocols in this population is extremely limited.
Methods: We implemented an intensive BG control protocol at the Mid America Heart Institute (MAHI) CCU beginning 08/2006, with the purpose of evaluating its feasibility, safety and effectiveness. All ACS patients with admission BG >140 mg/dL received a modified Yale-MAHI intravenous insulin infusion protocol, with a target BG range of 90–120 mg/dL. Demographic, clinical and laboratory data were abstracted from medical records of 94 consecutive pts that received the protocol (post-intervention), and compared with data on 138 consecutive ACS pts with admission BG >140 mg/dL hospitalized in CCU immediately prior to the protocol implementation (pre-intervention).
Results: There were no significant differences between pre and post-intervention pts in age (64 vs. 66, p=0.2), female gender (40 vs. 39%, p=0.8), known diabetes (57 vs. 51%, p=0.3), or admission BG (218 vs. 203 mg/dL, p=0.13). Mean 24 hour BG was markedly reduced in post-intervention vs. pre-intervention pts (132 vs. 181 mg/dL, p<0.001). The protocol was very effective in both rapid attainment and maintenance of BG targets (Figure⇓). The rate of hypoglycemia (BG <60 mg/dL) was 0.72%, and none of the hypoglycemic events were symptomatic.
Conclusions: Intensive BG control in critically ill ACS patients with the modified Yale-MAHI protocol is feasible, effective and safe.