Management of Diabetes and/or Hyperglycemia in Acute Coronary Syndrome, Acute Stroke, and Acute Heart Failure

Chapter 39 Management of Diabetes and/or Hyperglycemia in Acute Coronary Syndrome, Acute Stroke, and Acute Heart Failure Miles Fisher, Miles FisherSearch for more papers by this author Miles Fisher, Miles FisherSearch for more papers by this author Book Editor(s):Glenn Matfin, Glenn MatfinSearch for more papers by this author First published: 02 March 2018 https://doi.org/10.1002/9781119374800.ch39 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onFacebookTwitterLinked InRedditWechat Summary The importance of cardiovascular disease in diabetes mellitus is well established. Cardiovascular disease is a common cause of morbidity and mortality in people with diabetes. The modern multifaceted management of type 2 diabetes, with a focus on the treatment of hypertension and the use of statins, has reduced the prevalence of atherosclerotic cardiovascular disease. When looked at from a vascular perspective, diabetes is common in patients admitted to coronary care and acute stroke units, and when patients with diagnosed diabetes are excluded, around one-third of remaining patients in these units have newly-diagnosed diabetes and one-third have prediabetes. This proportion is likely to increase as the prevalence of diabetes increases. The metabolic and endocrine response to acute illness includes the release of counter-regulatory hormones which can provoke and worsen hyperglycemia. Emergency treatment with insulin following myocardial infarction to try and reduce mortality is an intervention that has been tested for over 40 years, with mixed and conflicting results. This chapter examines the evidence for the treatment of hyperglycemia in patients with acute coronary syndrome, acute stroke, and acute heart failure. The evidence that long-term treatment with intensive glycemic control or with specific anti-diabetes drugs might reduce recurrent events in patients who have survived the acute episode is also examined. Endocrine and Metabolic Medical Emergencies: A Clinician's Guide, Second Edition RelatedInformation