James Scheuer, MD
Professor Emeritus, Department of Medicine (Cardiology)
Diabetes plays a significant role in cardiovascular disease, with over half of diabetes-related deaths stemming from coronary- and cerebrovascular-related complications. Blood glucose level fluctuation--specifically, increased serum catecholamines and decreased insulin--are thought to play a role in acute myocardial infarction (AMI). Persistent hyperglycemia may also predict adverse cardiac effects in nondiabetic patients. Einstein-Montefiore investigators from the Divisions of Cardiology and Endocrinology are currently examining the effects of close glycemic monitoring and control on AMI outcomes.
In 2004, the Division of Endocrinology instituted a continuous insulin infusion therapy (CIIT) protocol in the Montefiore coronary care units (CCUs). Under the protocol, diabetic patients with glucose levels over 100mg/dl and nondiabetic patients with glucose levels over 150/dl receive insulin infusion during the first 24 hours of care. Early results showed that the protocol needed revision.
Researchers are currently conducting a two-year study of approximately 500 patients, aiming to determine the CIIT protocol's effectiveness in the following areas:
- level of glycemic control achieved in the CCUs
- appropriateness and timing of implementing the protocol
- efficacy in controlling patients' blood glucose levels throughout their hospitalization
- adequacy of the discharge treatment plan
- effect on mortality and length of stay; trends in patients' blood pressure, renal and cardiac function; and determining incidences of undiagnosed diabetes in hyperglycemic patients
This investigation will provide accurate information on whether or not the Montefiore CIIT protocol has been effective in controlling hyperglycemia post MI, implement corrective action if indicated, and identify other areas of improvement.
In response to this study, the current protocol will likely be revised, leading to improved medical care for patients with diabetes or high blood glucose who experience myocardial infarctions.