How to Manage Hyperglycemia in an Acute Coronary Syndrome Patient

  • David Vivas
  • Esther Bernardo
  • Julian Palacios-Rubio
  • Antonio Fernández-Ortiz
Coronary Artery Disease (PG Steg, Section Editor)

Opinion statement

Evidences on hyperglycemia management in patients with acute coronary syndrome (ACS) are scarce and controversial. While approaches such as infusion of glucose, insulin, and potassium (GIK therapy) have not demonstrated any improvement in outcome, glycemic control by means of either continuous insulin infusion or subcutaneous on-demand boluses may be useful only when glycaemia is successfully controlled. Nevertheless, results from several studies are controversial and there is no consensus on glycaemia target values. Concerning oral antidiabetic treatment, previous reports stated an increase in heart attacks throughout their chronic use, however no studies have addressed the effects of either starting or continuing oral antidiabetics during ACS setting. Therefore, there is not enough evidence to strongly recommend any specific therapy to manage hyperglycemia in an ACS patient other than trying to keep glycaemia within reasonable levels (usually defined by consensus), and there is evidence discouraging the use of GIK therapy since no beneficial effect has been observed.

Keywords

Hyperglycemia Acute coronary syndrome Diabetes mellitus Platelets Insulin Oral antidiabetic drugs Acute myocardial infarction Thrombosis 

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • David Vivas
    • 1
  • Esther Bernardo
    • 1
  • Julian Palacios-Rubio
    • 1
  • Antonio Fernández-Ortiz
    • 1
  1. 1.Instituto CardiovascularHospital Universitario San CarlosMadridSpain

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