Differentiated approach to glycemic management in type 2 diabetic patients during inpatient treatment of acute myocardial infarction: glycemic control and long-term prognosis

Abstract

BACKGROUND: The risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM) is 2 times higher than without DM. Previously an association between the time in the target range of glycemia during hospitalization of AMI in patients with T2DM (hTIR — «hospital time in range») and long-term prognosis was found. It is supposed that a differentiated approach to glycemic management will help to achieve a higher level of hTIR and will lead to an improved prognosis.AIM: To evaluate the effectiveness of differentiated approach to glycemic management in patients with T2DM during inpatient treatment of AMI and impact on long-term prognosis.MATERIALS AND METHODS: The study included patients with T2DM who were hospitalized with AMI with ST-segment elevation and underwent percutaneous coronary intervention. A total amount of patients was 161; 102 were in the main group, 59 in the control group. There was a differentiated approach to glycemia management based on phenotype determination in the main group. Insulin therapy was prescribed to patients with the 1st phenotype during the entire inpatient treatment. Patients with the second phenotype received insulin therapy followed by switching oral antidiabetic drugs (OAD). Patients of the 3rd phenotype were prescribed only OAD. In the control group, therapy of T2DM was prescribed according to the standard hospital procedures based on current clinical recommendations.RESULTS: In the main group, 22 patients (22%) were in the 1st phenotype, 54 (53%) –in the 2nd, 26 (25%) –in the 3rd. The average glycemia during hospitalization in the main group was lower than in the control group: 9.4±1.7 mmol/l vs 10.3±2.3 mmol/l (p=0.006). The hTIR in the main group was 58 [53; 71]% vs 46 [33; 63]% in the control group (p<0.001). It was shown that when hTIR > 55% is reached, the risk of cardiovascular death within a year after hospitalization is reduced by 80%.CONCLUSION: The differentiated approach to glycemic management in patients with T2DM leads to an improvement in glycemic control during inpatient treatment of AMI and is accompanied by a tendency to a lower incidence of cardiovascular death within a year after hospitalization. Achieving hTIR > 55% is associated with a multifold reduction of the risk of cardiovascular death in a year. About 25% of patients with DM2 during inpatient treatment of AMI do not need the insulin therapy.