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STATE-OF-THE-ART PAPER

Lowering Glucose to Prevent Adverse Cardiovascular Outcomes in a Critical Care Setting

Antonio Ceriello, MD^_*,_*, Stuart W. Zarich, MD and Roberto Testa, MD

^_* Centre of Excellence in Diabetes and Endocrinology, University Hospital of Coventry and Warwickshire, Warwick Medical School, University of Warwick, Coventry, United Kingdom
Division of Cardiovascular Medicine, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut
Department of Gerontological Research, Diabetology Unit, INRCA, Ancona, Italy

Manuscript received April 7, 2008; revised manuscript received September 16, 2008, accepted September 23, 2008.

^_* Reprint requests and correspondence: Dr. Antonio Ceriello, Warwick Medical School, Clinical Science Research Institute, Clinical Science Building, University Hospital-Walsgrave Campus, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom (Email: antonio.ceriello{at}warwick.ac.uk).

High admission blood glucose levels after acute myocardial infarction are common and associated with an increased risk of death in patients with or without diabetes. Hyperglycemia is associated with altered myocardial blood flow and energetics and can lead to a pro-oxidative/proinflammatory state. The use of intensive insulin treatment has shown superior benefits in the treatment of hyperglycemia versus glucose-insulin-potassium infusion, particularly in critical care settings.

Key Words: insulin • impaired glucose tolerance • diabetes • myocardial infarction

Abbreviations and Acronyms   ACS = acute coronary syndrome   AMI = acute myocardial infarction   ATP = adenosine triphosphate   CABG = coronary artery bypass grafting   CI = confidence interval   CV = cardiovascular   FFA = free fatty acid   GIK = glucose-insulin-potassium   ICU = intensive care unit   SPRINT = Specialized Relative Insulin and Nutrition Tables   T2DM = type 2 diabetes mellitus

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