Greater management of hyperglycaemia in patients with acute coronary syndromes needed
Patients with acute coronary syndromes (ACS) should have their blood glucose levels actively controlled if it is raised on admission to hospital, says NICE.
Hyperglycaemia, an excess of glucose in the blood, is common among people admitted to hospital with a range of conditions encompassed by ACS, such as heart attack and unstable angina.
Patients with hyperglycaemia have a poorer chance of survival and increased complications while in hospital, regardless of whether they have diabetes.
However, guidance published by NICE today states that hyperglycaemia is not being considered as a risk factor for ACS, and frequently remains untreated.
The NICE guideline on hyperglycaemia in acute coronary syndromes covers the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours in people admitted to hospital.
The guideline says hyperglycaemia should be managed by keeping blood glucose levels below 11.0 mmol/litre while avoiding hypoglycaemia, which is where blood glucose levels are below normal, usually less than 4 mmol/litre.
In the first instance healthcare professionals should consider a dose-adjusted insulin infusion with regular monitoring of blood glucose levels.
Intensive insulin therapy, which is an intravenous infusion of insulin and glucose with or without potassium, should not be routinely offered to manage hyperglycaemia unless clinically indicated.
The guideline also contains recommendations for identifying patients with hyperglycaemia after ACS who are at high risk of developing diabetes.
It states that all patients with hyperglycaemia after ACS and without diabetes should be offered tests for HbA1c levels before discharge and fasting blood glucose levels no earlier than 4 days after the onset of ACS.
The HbA1c test measures the amount of glucose that is being carried by red blood cells in the body and indicates blood glucose levels for the past two to three months. Patient discharge should not be delayed by the carrying out of these tests.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: “We know that hyperglycaemia in patients who are admitted to hospital with ACS is a powerful predictor of poorer survival and increases the risk of complications, regardless of whether or not they have diabetes.
“I am sure this guideline will be a useful aid for healthcare professionals who treat and manage this condition.”
The guideline also recommends that healthcare professionals advise patients without known diabetes that they are at risk of developing type 2 diabetes, if they have had hyperglycaemia after ACS.
Furthermore, patients who have had hyperglycaemia after ACS without known diabetes should receive ongoing monitoring and be given lifestyle advice.
This should include advice in accordance with NICE guidelines on eating healthily, physical exercise, weight management, quitting smoking and alcohol consumption.
A range of tools have been produced alongside this guideline to help action the recommendations, including an audit support tool and an educational slide set.
Visit the NICE Pathway on Hyperglycaemia in acute coronary syndromes for quick and easy access to all the recommendations covered in the guideline.
26 October 2011