New NICE guideline published on hyperglycaemia in acute coronary syndromes

NICE has today (26 October) published a new guideline on the management of hyperglycaemia (raised blood sugar)i in people with acute coronary syndromes (ACS). ACS encompasses a range of conditions from unstable angina to myocardial infarction (heart attack)ii.

Hyperglycaemia is common in people with ACS and recent studies suggest that 65% of patients with acute myocardial infarction who were not known to have diabetes had impaired glucose regulation as shown by a glucose blood test. Hyperglycaemia (in those with or without diabetes) is associated with complications and poor outcomes.

The guideline covers the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours in people admitted to hospital for acute coronary syndromes. Recommendations include:

  • Managing hyperglycaemia by keeping blood glucose levels below 11.0 mmol/litre while avoiding hypoglycaemiaiii. In the first instance, consider a dose-adjusted insulin infusion with regular monitoring of blood glucose levels.
  • Not routinely offering intensive insulin therapy (an intravenous infusion of insulin and glucose with or without potassium) to manage hyperglycaemia unless clinically indicated.

For identifying patients with hyperglycaemia after ACS who are at high risk of developing diabetes, recommendations include:

  • Offering all patients with hyperglycaemia after ACS and without known diabetes, tests for:
  • HbA1civ levels before discharge and
  • fasting blood glucose levels no earlier than four days after the onset of ACS.

These tests should not delay discharge.

The guideline also recommends that patients without known diabetes should be advised that if they have had hyperglycaemia after an ACS they are at increased risk of developing type 2 diabetes. Such patients should be offered tests for diabetes by their GP at least annually. Advice on lifestyle changes, which can reduce the risk of developing both diabetes and further coronary heart disease, should also be given in line with existing NICE guidance.

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."


Notes to Editors

About the guidance

1. The new NICE clinical guideline, Hyperglycaemia in acute coronary syndromes: management of hyperglycaemia in people with acute coronary syndromes is available on the NICE website from Wednesday 26 October at:

Contact the press office for an embargoed copy.

2. The guideline covers adults admitted to hospital for an acute coronary syndrome regardless of whether or not they have a diagnosis of diabetes.

3. More information on developing NICE short clinical guidelines.


i. Hyperglycemia, or high blood sugar, is a condition in which an excessive amount of glucose, above 11 mmol/litre, circulates in the blood.

ii. Unstable angina is a heart condition which may cause chest pain or discomfort. The pain is caused by a blockage or narrowing of one of the main blood vessels to the heart (coronary arteries). This usually happens when a person has coronary heart disease, which is caused by a build up of fatty materials in the walls of the artery.

Myocardial infarction, commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing cells to die. It often occurs because of a blockage in a coronary artery.

iii. Hypoglycaemia, or low blood sugar, is a condition whereby blood glucose levels are below the normal range (usually less than 4 mmol/litre).

iv. The HbA1c test indicates blood glucose levels for the previous two to three months. HbA1c measures the amount of glucose that is being carried by the red blood cells in the body.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 25 October 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.