Recommendations for Diabetes Mellitus
| 2007 Recommendations | 2011 Focused Update Recommendations | Comments |
|---|---|---|
| Class I | ||
| Medical treatment in the acute phase of UA/NSTEMI and decisions on whether to perform stress testing, angiography, and revascularization should be similar in patients with and without diabetes mellitus. (Level of Evidence: A) | 1. Medical treatment in the acute phase of UA/NSTEMI and decisions on whether to perform stress testing, angiography, and revascularization should be similar in patients with and without diabetes mellitus.25,26,42,140 (Level of Evidence: A) | 2007 recommendation remains current. |
| In all patients with diabetes mellitus and UA/NSTEMI, attention should be directed toward aggressive glycemic management in accordance with current standards of diabetes care endorsed by the American Diabetes Association and the American College of Endocrinology. Goals of therapy should include a preprandial glucose target of <110 mg per dL and a maximum daily target of <180 mg per dL. The postdischarge goal of therapy should be HbA1C <7%, which should be addressed by primary care and cardiac caregivers at every visit. (Level of Evidence: B) | Deleted recommendation (defer to American Diabetes Association Guidelines141). | |
| An IV GP IIb/IIIa inhibitor should be administered for patients with diabetes mellitus as recommended for all UA/NSTEMI patients (Section 3.2). (Level of Evidence: A) The benefit may be enhanced in patients with diabetes mellitus. (Level of Evidence: B) | Deleted recommendation (deleted to avoid redundancy; refer toTables 2 and 3). | |
| Class IIa | ||
| For patients with UA/NSTEMI and multivessel disease, CABG with use of the internal mammary arteries can be beneficial over PCI in patients being treated for diabetes mellitus. (Level of Evidence: B) | 1. For patients with UA/NSTEMI and multivessel disease, CABG with use of the internal mammary arteries can be beneficial over PCI in patients being treated for diabetes mellitus.142 (Level of Evidence: B) | 2007 recommendation remains current. |
| PCI is reasonable for UA/NSTEMI patients with diabetes mellitus with single-vessel disease and inducible ischemia. (Level of Evidence: B) | 2. PCI is reasonable for UA/NSTEMI patients with diabetes mellitus with single-vessel disease and inducible ischemia.25,142 (Level of Evidence: B) | 2007 recommendation remains current. |
| In patients with UA/NSTEMI and diabetes mellitus, it is reasonable to administer aggressive insulin therapy to achieve a glucose <150 mg per dL during the first 3 hospital (intensive care unit) days and between 80 and 110 mg per dL thereafter whenever possible. (Level of Evidence: B) | 3. It is reasonable to use an insulin-based regimen to achieve and maintain glucose levels < 180 mg/dL while avoiding hypoglycemia* for hospitalized patients with UA/NSTEMI with either a complicated or uncomplicated course.143–146 (Level of Evidence: B) | Modified recommendation (language changed to be concordant with 2009 STEMI and PCI Focused Update32). |
* There is uncertainty about the ideal target range for glucose necessary to achieve an optimal risk-benefit ratio.