Reviews in Endocrine and Metabolic Disorders

, Volume 11, Issue 1, pp 87–94

Overview of the importance of glycaemic control for cardiovascular events in the in-and out-patient setting

  • Matteo Anselmino
  • Klas Malmberg
  • Linda Mellbin
  • Lars Rydén
Article

Abstract

Worldwide prevalence of diabetes mellitus in the adult population is increasing and when explicitly searched within specific groups of patients, as those presenting cardiovascular disease (CVD), dysglycaemia is detected in about three-quarters of the patients. Dysglycaemia alone is a major risk factor for microvascular and macrovascular complications that impair quality of life and diminish survival. The coexistence of CVD and dysglycaemia in the same individual increases its cardiovascular risk considerably. Since a significant proportion of dysglycaemic individuals develop vascular damage and the disturbed glucose metabolism remains undetected until the first cardiovascular event, there is imperative need for improved strategies for glucometabolic health assessment and management in patients with CVD. The present review has the aim to discuss the importance of glycaemic control for future cardiovascular events starting from the in-hospital setting and continuing to long-term management based on available literature and recently updated international guidelines.

Keywords

Glycaemic control Diabetes mellitus Cardiovascular events Prevention 

References

  1. 1.
    King H, Aubert RE, Herman WH. Global burden of diabetes 1995–2025. Prevalence, numerical estimates and projections. Diabetes Care. 1998;21:1414–31.CrossRefPubMedGoogle Scholar
  2. 2.
    Boyle JP, Honeycutt AA, Narayan VKM, Hoerger TJ, Geiss LS, Chen H, et al. Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care. 2001;24:1936–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, et al. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation. 2000;102:1014–9.PubMedGoogle Scholar
  4. 4.
    Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendic S, Rydén L, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359:2140–4.CrossRefPubMedGoogle Scholar
  5. 5.
    World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Available at www.who.com.
  6. 6.
    Bartnik M, Rydén L, Ferrari R, Malmberg K, Pyorala K, Simoons M, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J. 2004;25:1880–90.CrossRefPubMedGoogle Scholar
  7. 7.
    Hu D, Pan CY, Yu J. The relationship between coronary artery disease and abnormal glucose regulation in China—The China Heart Survey. Eur Heart J. 2006;27:2573–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Nelson RG, Tan M, Beck GJ, Bennett PH, Knowler WC, Mitch WE, et al. Changing glomerular filtration with progression from impaired glucose tolerance to Type II diabetes mellitus. Diabetologia. 1999;42:90–3.CrossRefPubMedGoogle Scholar
  9. 9.
    Koopman RJ, Mainous III AG, Liszka HA, Colwell JA, Slate EH, Carnemolla MA, et al. Evidence of nephropathy and peripheral neuropathy in US adults with undiagnosed diabetes. Ann Fam Med. 2006;4:427–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Jarret RJ, Keen H. Hyperglycaemia and diabetes mellitus. Lancet. 1976;2:1009–12.CrossRefGoogle Scholar
  11. 11.
    Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis. Diabetes Care. 1992;15:815–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Levitan EB, Song Y, Ford ES, Liu S. Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies. Arch Intern Med. 2004;164:2147–55.CrossRefPubMedGoogle Scholar
  13. 13.
    Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coronary heart disease risk and impaired glucose tolerance. The Whitehall study. Lancet. 1980;1:1373–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Rodriguez BL, Lau N, Bruchfiel CM, Abbott RD, Sharp DS, Yano K, et al. Glucose intolerance and 23-year risk of coronary heart disease and total mortality. The Honolulu Heart Program. Diabetes Care. 1999;22:1262–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Balkau B, Shipley M, Jarrett RJ, Pyörälä K, Pyörälä M, Forhan A, et al. High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men. 20-year follow-up in the Whitehall Study, the Paris Prospective Study and the Helsinki Policemen Study. Diabetes Care. 1998;21:360–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events: a metaregression analysis of published data from 20 studies of 95.783 individuals followed for 12.4 years. Diabetes Care. 1999;22:233–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Lenzen M, Rydén L, Ohrvik J, Bartnik M, Malmberg K, Scholte Op, et al. Diabetes known or newly detected, but not impaired glucose regulation, has a negative influence on 1-year outcome in patients with coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart. Eur Heart J. 2006;27:2969–74.CrossRefPubMedGoogle Scholar
  18. 18.
    Wylie G, Hungin AP, Neely J. Impaired glucose tolerance: qualitative and quantitative study of general practitioners’ knowledge and perceptions. BMJ. 2002;324:1190.CrossRefPubMedGoogle Scholar
  19. 19.
    Whitford DL, Lamont SS, Crosland A. Screening for Type 2 diabetes: is it worthwhile? Views of general practitioners and practice nurses. Diabet Med. 2003;20:155–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Williams R, Rapport F, Elwyn G, Lloyd B, Rance J, Belcher S. The prevention of type 2 diabetes: general practitioner and practice nurse opinions. Br J Gen Pract. 2004;54:531–5.PubMedGoogle Scholar
  21. 21.
    International Diabetes Federation. Fact sheet: Impaired glucose tolerance (IGT). Available at www.idf.org.
  22. 22.
    Bartnik M, Ryden L, Malmberg K, Ohrvik J, Pyorala K, Standl E, et al. Oral glucose tolerance test is needed for appropriate classification of glucose regulation in patients with coronary artery disease: a report from the Euro Heart Survey on Diabetes and the Heart. Heart. 2007;93:72–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Rydén L, Standl E, Bartnik M, Van den BG, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007;28:88–136.CrossRefPubMedGoogle Scholar
  24. 24.
    Mehta SR, Yusuf S, Diaz R, Zhu J, Pais P, Xavier D, et al. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial. JAMA. 2005;293:437–46.CrossRefPubMedGoogle Scholar
  25. 25.
    Malmberg K, Rydén L, Efendic S, Herlitz J, Nicol P, Waldenström A, 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.CrossRefPubMedGoogle Scholar
  26. 26.
    Malmberg K, Rydén L, Wedel H, Birkeland K, Bootsma A, Dickstein K, et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26:650–61.CrossRefPubMedGoogle Scholar
  27. 27.
    van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–67.CrossRefPubMedGoogle Scholar
  28. 28.
    van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.CrossRefPubMedGoogle Scholar
  29. 29.
    Cheung NW, Wong VW, McLean M. The Hyperglycemia: intensive Insulin Infusion in Infarction (HI-5) study: a randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care. 2006;29:765–70.CrossRefPubMedGoogle Scholar
  30. 30.
    The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically Ill patients. N Engl J Med. 2009;360:1283–97.CrossRefGoogle Scholar
  31. 31.
    Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T, et al. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2008;117:1610–9.CrossRefPubMedGoogle Scholar
  32. 32.
    UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–65.CrossRefGoogle Scholar
  33. 33.
    Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med. 2008;359:1577–89.CrossRefPubMedGoogle Scholar
  34. 34.
    Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. New Engl J Med. 2005;353:2643–53.CrossRefPubMedGoogle Scholar
  35. 35.
    Lincoff AM, Wolski K, Nicholls SJ, Nissen SE. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA. 2007;298:1180–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356:2457–71.CrossRefPubMedGoogle Scholar
  37. 37.
    Singh S, Loke YK, Furberg CD. Long-term risk of cardiovascular events with rosiglitazone: a meta-analysis. JAMA. 2007;298:1189–95.CrossRefPubMedGoogle Scholar
  38. 38.
    Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, et al. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet. 2006;368:1096–105.CrossRefPubMedGoogle Scholar
  39. 39.
    Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (Prospective Pioglitazone Clinical Trial in Macrovascular Events): a randomised controlled trial. Lancet. 2005;366:1279–89.CrossRefPubMedGoogle Scholar
  40. 40.
    Anselmino M, Ohrvik J, Malmberg K, Standl E, Ryden L. Glucose lowering treatment in patients with coronary artery disease is prognostically important not only in established but also in newly detected diabetes mellitus: a report from the Euro Heart Survey on Diabetes and the Heart. Eur Heart J. 2008;29:177–84.CrossRefPubMedGoogle Scholar
  41. 41.
    Mellbin LG, Malmberg K, Norhammar A, Wedel H, Ryden L. The impact of glucose lowering treatment on long-term prognosis in patients with type 2 diabetes and myocardial infarction: a report from the DIGAMI 2 trial. Eur Heart J. 2008;29:166–76.CrossRefPubMedGoogle Scholar
  42. 42.
    BARI 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–15.CrossRefGoogle Scholar
  43. 43.
    Stettler C, Allemann S, Jüni P, Cull CA, Holman RR, Egger M, et al. Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: meta-analysis of randomized trials. Am Heart J. 2006;152:27–38.CrossRefPubMedGoogle Scholar
  44. 44.
    Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39.CrossRefPubMedGoogle Scholar
  45. 45.
    Gerstein HC, Miller ME, Byington RP, Goff Jr DC, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.CrossRefPubMedGoogle Scholar
  46. 46.
    Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.CrossRefPubMedGoogle Scholar
  47. 47.
    Ray KK, Seshasai SR, Wijesuriya S, Sivakumaran R, Nethercott S, Preiss D, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet. 2009;373:1765–72.CrossRefPubMedGoogle Scholar
  48. 48.
    Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009;52:2288–98.CrossRefPubMedGoogle Scholar
  49. 49.
    Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial interventions and cardiovascular disease in patients with type 2 diabetes mellitus. N Engl J Med. 2003;348:383–93.CrossRefPubMedGoogle Scholar
  50. 50.
    Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358:580–91.CrossRefPubMedGoogle Scholar
  51. 51.
    Anselmino M, Malmberg K, Öhrvik J, Ryden L. Evidence-based medication and revascularization: powerful tools in the management of patients with diabetes and coronary artery disease. A report from the Euro Heart Survey on Diabetes and the Heart. Eur J Cardiovasc Prev Rehabil. 2008;15:216–23.CrossRefPubMedGoogle Scholar
  52. 52.
    The ORIGIN Trial Investigators. Rationale, design and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: The ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). Am Heart J. 2008;155:26–32.Google Scholar
  53. 53.
    Holman RR, Pan CY. Acarbose Cardiovascular Evaluation (ACE) trial in prediabetic subjects. Presented at the 2nd International Congress on Prediabetes and the Metabolic Syndrome, April 25–28, 2007.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Matteo Anselmino
    • 1
  • Klas Malmberg
    • 2
  • Linda Mellbin
    • 2
  • Lars Rydén
    • 2
    • 3
  1. 1.Division of Cardiology, Department of Internal MedicineUniversity of TurinTurinItaly
  2. 2.Cardiology Unit, Department of MedicineKarolinska InstitutetStockholmSweden
  3. 3.Department of CardiologyKarolinska University HospitalStockholmSweden

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