This document discusses screening for coronary artery disease (CAD) in asymptomatic patients with diabetes. It notes that while CAD risk is elevated in diabetic patients, widespread screening is not currently recommended due to a lack of evidence that it improves outcomes. Some key points made in the document:
- The risk of CAD is higher and often silent in diabetic patients. However, screening the large number of diabetic patients is very costly, and it is unclear if treating silent CAD found on screening would actually help patients.
- Two studies found that screening stress SPECT imaging found abnormal results in only 16-17% of asymptomatic diabetic patients.
- More data is still needed to determine if screening can identify a high-risk group of diabetic patients
COMPARES OPTIMAL MEDICAL THERAPY WITH INVASIVE THERAPY IN A PATIENT WITH STABLE ISCHEMIC HEART DISEASE WITH MODERATE TO SEVERE MYOCARDIAL ISCHEMIA ON NON INVASIVE STRESS TESTING
We have made great strides in the treatment of cancer. More individuals are surviving a cancer diagnosis, but cancer treatments can have a detrimental impact on cardiovascular health.
Dr. Susan Dent, a medical oncologist who co-founded the first multidisciplinary cardio-oncology clinic in Canada, discussed the importance of optimizing cardiovascular health for patients during and following completion of their cancer treatment.
COMPARES OPTIMAL MEDICAL THERAPY WITH INVASIVE THERAPY IN A PATIENT WITH STABLE ISCHEMIC HEART DISEASE WITH MODERATE TO SEVERE MYOCARDIAL ISCHEMIA ON NON INVASIVE STRESS TESTING
We have made great strides in the treatment of cancer. More individuals are surviving a cancer diagnosis, but cancer treatments can have a detrimental impact on cardiovascular health.
Dr. Susan Dent, a medical oncologist who co-founded the first multidisciplinary cardio-oncology clinic in Canada, discussed the importance of optimizing cardiovascular health for patients during and following completion of their cancer treatment.
This study uses consecutive National Health and Nutrition Examination Surveys (NHANES) data from 2003-2012 to concurrently model obese body size (c.f., normal weight) main effects, moderated by nondiabetic moderate 10-year ASCVD risk (c.f., 30-year and diabetic), on total medical cost outcomes.
• Minors, seniors 76+, outlier diseases, and pregnant women were excluded, resulting in 192,447,424 weighted or 22,510 unweighted participants.
This study uses consecutive National Health and Nutrition Examination Surveys (NHANES) data from 2003-2012 to concurrently model obese body size (c.f., normal weight) main effects, moderated by nondiabetic moderate 10-year ASCVD risk (c.f., 30-year and diabetic), on total medical cost outcomes.
• Minors, seniors 76+, outlier diseases, and pregnant women were excluded, resulting in 192,447,424 weighted or 22,510 unweighted participants.
Screening for diabetes and its complications as part of the Alberta Diabetes ...Kelli Buckreus
2004 (Jan) 3rd National Conference on Diabetes and Aboriginal Peoples, National Aboriginal Diabetes Association (NADA), poster presentation by BRAID Research
All what you have to know about Diabetes MellitusYapa
All what you have to know about Diabetes Mellitus is here.Introduction of Diabetes,Regulation of blood glucose,Predisposing factors of DM,Clinical presentation,DM and pregnancy ,Diabetes ketoacidosis ,Complications of DM ,Diagnosis ,Dietary management of DM & Prevention of DM.
Student seminar on Diabetes Mellitus presented by 2007/2008 Batch students of Faculty of Medicine,University of Peradeniya,Sri Lanka.
Buy Accu chek active glucometer,test strips and other branded glucose meter in Diabeticpick.com. Shop for best diabetic products online, get free shipping.
Life Style and Nutritional profile of NIDDM patients.Runa La-Ela
Life Style and Nutritional profile of NIDDM patients.
Diabetes mellitus is one of the most burdensome chronic diseases that are increasing in epidemic proportion throughout the world.
Obesity and physical inactivity constitute part of the risk for NIDDM because of their propensity to induce insulin resistance.
Food and dietary pattern of an individual have an important role to play in the development, treatment or prevention of NIDDM
Diabetes mellitus, its types and compicationsMohit Adhikary
Diabetes mellitus and the different types of it. The classification of the diabetes, description and the complications of diabetes. Spectrum and the Epidemiology.
Dyslipidemia and CVS by Mohit Soni and Chandan KumarOlgaGoryacheva4
My students Mohit Soni and Chandan Kumar had presented this topic in our 22nd Student Scientific Society Conference in the department of Propaedeutic of Internal Diseases No.2
Controlling heart disease in a high-risk group such as patients with diabetes requires an understanding and management of several factors (see slide deck). As usual, please consult a physician for specific case information.
Coronary heart disease is best addressed by a comprehensive approach aimed at halting atherosclerotic disease and reducing the risk of thrombosis. Unfortunately, our success in optimal risk factor modification in patients with stable CHD remains poor: only 41% of patients achieved all basic goals in the recent ISCHEMIA trial, with success rates likely even lower outside the rigorous clinical trial context. A greater focus on achieving prevention goals in patients with CHD will have a substantial impact on patient outcome and rates of hospitalization and more resources and incentives should be allocated for improved secondary prevention.
The ISCHEMIA trial suggests that even selected, high-risk patients with extensive ischemic burden do not benefit from revascularization barring unacceptable angina despite OMT. As ISCHEMIA excluded patients with unacceptable angina, advanced heart failure, and those with unprotected left main disease, our evaluation may be geared to identify such patients for consideration of revascularization alongside an initial strategy of OMT.
Atherosclerosis is a systemic disease of the arterial circulation, with focal areas of more severe manifestation. From an imaging standpoint, the paradigm of ischemia testing may have come to an end. Recent evidence from COURAGE, PROMISE, SCOT-HEART, and ISCHEMIA has demonstrated that functional testing for inducible myocardial ischemia is inferior to anatomic assessment for risk stratifying and managing patients with suspected or known CHD. Consistent with a large body of evidence, risk from CHD is mediated by the extent of atherosclerotic disease burden and not by the extent of inducible ischemia. Given that 55% of patients had nonobstructive CHD by CT in PROMISE, which was associated with 77% of cardiovascular deaths and myocardial infarctions at follow-up, there is immense opportunity to impact the disease at an earlier stage in a very large population of patients with occult CHD.
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
In this slide i outlined an open source article, how already 12 years have elapsed over it's publication. I thought it is interesting and i am also sharing it's fulltext link: https://diabetes.diabetesjournals.org/content/56/6/1718
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. • The incidence of diabetes mellitus has increased at an
alarming rate over the past 2 decades. Current estimates
of the numbers of people with diabetes include 17.7
million in the U.S. and 171 million worldwide . These
numbers are projected to double by the year 2030.
• The association between diabetes and cardiovascular
disease is well established . Coronary artery disease
(CAD) is the leading cause of death in diabetic patients,
accounting for 75% of the deaths .
• Coronary artery disease is also more often silent in
patients with diabetes .
Epidemiology
3.
4.
5.
6.
7. • Given the elevated risk of cardiovascular events and the higher
prevalence of silent coronary artery disease (CAD) in diabetic
versus non-diabetic patients, screening asymptomatic diabetic
patients for CAD is an appealing concept.
• However, many factors argue against implementing a broad-
based screening program at the present time.
• Foremost is the lack of any published data demonstrating that a
prospectively applied screening program improves outcome in
asymptomatic diabetic patients.
Screening for CAD in asymptomatic diabetic patients
8. •Consensus documents recommend more aggressive
treatment of hypertension and hyperlipidemia solely on
the basis of diabetes status, without differentiation
based on the presence or absence of identifiable CAD.
There is no evidence that use of anti-ischemic
medication can alter the natural history of CAD in these
patients.
9. • However, the DIAD (Detection of Ischemia in Asymptomatic
Diabetics) study, reported a much lower percentage of abnormal
SPECT images (16%) and images with a very large (10% of the
left ventricle) defect (1%).
• The financial implications of screening all asymptomatic diabetic
patients determined to be at intermediate and high risk by
clinical scoring systems is enormous. Clearly more data are
needed to address this issue. Future studies should consider
possible methods to enrich the patient subset that might benefit
from screening and should include carefully performed cost-
effective analyses.
J Am Coll Cardiol 2006
10. • The screening test must accurately characterize low- and
high-risk patients.
• Stress SPECT is well-established for its risk stratifying
properties . According to ACC/AHA guidelines , patients
characterized as low risk should have an annual cardiac
death rate 1%.
• The annual risk of cardiac death or nonfatal myocardial
infarction in general patient populations with normal SPECT
images is 0.6% . The ability of stress SPECT to identify low-
risk diabetic patients might not be as accurate.
11. • In the Cedars-Sinai study , the annual rate of cardiac death or
nonfatal myocardial infarction in asymptomatic diabetic
patients with normal images was 1.6%. In the Mayo Clinic study
, annual mortality in patients categorized as low risk by SPECT
was 3.6%.
• Identification of individuals afflicted with the disease should
lead to a treatment that improves outcome.
• However, A common argument for identifying CAD in
asymptomatic patients in general is to intensify treatment of
risk factors. This rationale might not apply to treatment of risk
factors in diabetic patients.
12. The National Cholesterol Education Program (NCEP) and Joint
committee of hypertension
• recommend more aggressive treatment of lipids and
hypertension, respectively, simply on the basis of diabetes
status. As noted in the AHA Prevention Conference the
results of a screening test in diabetic patients do not alter risk
factor management, because these patients are consid- ered
higher risk on the basis of diabetes alone
. .
• In clinical practice, beta-blockers are often prescribed to
patients with silent ischemia but without evidence that they
alter the natural history of chronic CAD.
-
13. • The goal of screening might be to identify individuals with
severe CAD who are candidates for revascularization.
• The BARI (Bypass and Angioplasty Revascularization
Intervention) trial compared outcomes in symptomatic patients
(two-thirds unstable angina) with multivessel CAD randomized
to coronary artery bypass grafting (CABG) or balloon
angioplasty. In the diabetic subset of patients, those assigned to
CABG had better survival (21). There are no randomized data
comparing treatment strategies in asymptomatic diabetic
patients.
14. • The process should be cost-effective.
• Bax et al. (5) recommend using clinical risk scores and
proceeding with stress SPECT in diabetic patients categorized as
intermediate or high risk.
• These scores are determined by age, gender, and the presence
and severity of risk factors. all diabetic men and women who are
60 years old are at intermediate risk, regardless of the presence
of any other risk factors.
• The proposal by Bax et al. would result in screening all diabetic
patients 60 years old and many younger patients with additional
risk factors.
• Of the 17 to 18 million patients with diabetes in the U.S.,
approximately 20% have recognized CAD . The number of the
remaining approximately 14 million who are intermediate or high
risk by clinical assessment is not known but is likely to be
substantial.
15. • Stress SPECT imaging is expensive, especially as currently
performed, with add-on costs for gated left ventricular ejection
fraction and wall motion measurements and additional
pharmaceutical charges for the radioisotope and adenosine).
• Bax et al. (5) suggest that computed tomography for coronary
artery calcium imaging has the potential to refine the screening
process, but published data are limited with mixed results (26,27).
More studies are necessary before recommending this approach.
• A cost- effective analysis of the screening process would need to
encompass not only the costs of noninvasive imaging but also
the costs of coronary angiography and revascularization
procedures that would be performed in patients with abnor mal
SPECT studies and include benefits of these proce- dures in
terms of increased quality-adjusted life-years.
16. CONCLUSIONS
• The detection of silent CAD in patients with diabetes will assume
even greater importance as a health issue in the future as the
number of people with diabetes increases.
• Clearly more studies are needed. Collection of follow-up data,
which is currently in progress in both the DIAD and BARI-2D
trials, might help clarify whether certain diabetic patients benefit
from screening.
• Although screening on the basis of multiple risk factors seems
intuitive, it is important to note that in both the DIAD and Mayo
Clinic studies, multiple risk factors did not predict which patients
had severely abnormal SPECT images.
• The Mayo Clinic studies demonstrated that there is a subset of
asymptomatic diabetic patients with severe CAD who can be
detected by SPECT and whose outcome might be enhanced by
CABG.
• However, the results from the DIAD study suggest that the yield
of detecting patients with severely abnormal images will be low
when SPECT is applied in a prospective manner as the first and
only test.
17. • A challenge for future studies will be to discover methods to
“enrich” the screened population to pre-select patients for SPECT
imaging. In the current era of escalating medical costs with an
emphasis on evidence-based medicine, it is difficult to support a
broad recommendation to screen all intermediate- and high-risk
asymptomatic diabetic patients with stress SPECT imaging only.
Until more data become available, clinicians should judiciously
apply screening tests on individual asymptomatic patients on the
basis of clinical judgment.
60. Understand what you can see and cannot see
Resolution
Penetration
Understand the basic morphology of images that you are
observing and its clinical relevance
Natural history and future event…
61.
62.
63.
64.
65.
66.
67.
68.
69. 3 layers of vessel wall in normal
vessel
Intima (I: High signal)
Media (M: Low signal)
Adventitia (A: high-iso signal)
Fibrous plaque
High signal low attenuation
and homogenous
77. Acute Coronary Syndrome
Checklist
SCREEN for DM among patients with
ACS
USE anti-platelet therapies, prasugrel
or ticagrelor, instead of clopidogrel in
patients with DM undergoing
percutaneous coronary intervention
(PCI)
2013
78. Screen for DM Among
Patients with ACS• Diabetes is a strong risk factor for
cardiovascular disease
• A significant proportion of patients with
ACS have undiagnosed DM
• Screening for DM is essential among
patients with ACS
– Can use FPG, A1C or 75g OGTT
79. Radke P W ,et al. Eur Heart J 2010;31:2971-3.
ACS Mortality in Diabetes vs. No Diabetes:
Changes Across the Eras
80. All patients with DM and ACS should receive
the same treatments as those without DM …
with some differences
81. Recommendation 1
1. Patients with ACS should be
screened for diabetes with a fasting
plasma glucose, A1C or 75 gram
OGTT prior to discharge from
hospital.[Grade D consensus]
2013
82. Recommendation 2
.2All patients with diabetes and ACS
should receive the same treatments
that are recommended for patients
with ACS without diabetes since they
benefit equally [Grade D, consensus].
83. Recommendation 3
.3Patients with diabetes and ACS
undergoing PCI should receive
antiplatelet therapy with prasugrel (if
clopidogrel-naïve, <75 years of age,
weight >65kg and no history of stroke)
[Grade A, Level 1] or ticagrelor [Grade B, Level 1],
rather than clopidogrel, to further
reduce recurrent ischemic events.
Patients with DM and non-STE ACS and higher risk
features, destined for a selective invasive strategy
should receive ticagrelor, rather than clopidogrel
[Grade B level 2]
2013
84. Recommendation 4
.4Patients with diabetes and non-STE
ACS and high risk features should
receive an early invasive strategy
rather than a selective invasive
approach to revascularization to
reduce recurrent coronary events,
unless contraindicated [Grade B Level 2].
2013
85. Recommendation 5
.5In patients with diabetes and STE-ACS,
the presence of retinopathy should not
be a contraindication to fibrinolysis [Grade
B, Level 2].
86. Recommendation 6
.6In-hospital management of diabetes
in ACS should include strategies to
avoid both hyperglycemia and
hypoglycemia:
–Blood glucose should be measured on
admission and monitored throughout the
hospitalization [Grade D, Consensus]
–Patients with acute MI and blood glucose
on admission of >11 mmol/L may receive
87. Recommendation 6 (continued)
.6In-hospital management of diabetes
in ACS should include strategies to
avoid both hyperglycemia and
hypoglycemia:
–Insulin therapy may be required to
achieve these targets [Grade D, consensus]. A
similar approach may be taken in those
with diabetes and admission blood glucose
<11.0 mmol/L [Grade D, consensus]