Glucose Control in Acute Myocardial Infarction: A Pilot Randomized Study Controlled by Continuous Glucose Monitoring System Comparing the Use of Insulin Glargine with Standard of Care

Background: Impaired glucose metabolism plays an important role in patients with acute myocardial infarction, but the clinical significance of glycemic variability (GV) early after the onset of ST-segment elevation myocardial infarction (STEMI) remains to be fully elucidated. Methods and Results:We prospectively investigated the clinical impact of GV, as determined by a continuous glucose monitoring system (CGMS), on left ventricular remodeling (LVR) assessed by cardiac magnetic resonance imaging (CMR) in 69 patients (63±13 years, 59 men) with a first reperfused STEMI within 12 h of onset. All patients were equipped with a CGMS when in a stable phase after admission and underwent repeat CMR at baseline and 7 months follow-up. Patients were divided into 2 groups according to the mean amplitude of glycemic excursions (MAGE). Patients in the upper tertile of MAGE were categorized as group High (H) and the other two-thirds as group Low (L). LVR was defined as an absolute increase in left ventricular end-diastolic volume index of ≥20%. LVR more frequently occurred in group H than in group L (56% vs. 11%, P<0.001). Multivariate analysis showed the higher MAGE group was an independent predictor of LVR in the chronic phase (odds ratio, 13.999; 95% confidence interval, 3.059 to 64.056; P=0.001).Conclusions: MAGE early after the onset of STEMI identified patients with LVR in the chronic phase. (Circ J 2015; 79: 1092 -1099

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“…24 Because MAGE calculated from CGMS data is considered the most important index of GV, we used that variable in the present study.…”

Section: Utility Of Gvmentioning

confidence: 99%

Glycemic Variability Determined by Continuous Glucose Monitoring System Predicts Left Ventricular Remodeling in Patients With a First ST-Segment Elevation Myocardial Infarction

Gohbara

Iwahashi

Kataoka

et al. 2015

Circ J

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“…Em estudo com população similar a nossa, Sampaio e col também demonstraram que o MCG é capaz de identificar hipoglicemias não detectadas pela GC em pacientes com IAM em uso de insulina 118 . Não encontramos correlação da média glicêmica com os outros métodos de avaliação plaquetária, bem como não encontramos correlação com o delta entre as visitas 1 e 2 e a MAGE, talvez devido ao pequeno número de pacientes incluídos nessa análise.…”

Section: Efeito Do I-dpp4 Sobre a Glicemiaunclassified

Uso do inibidor da DPP4 em pacientes portadores de diabetes tipo 2 com infarto agudo do miocárdio: efeitos na função plaquetária

Genestreti¹

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Dedico essa tese de doutorado a toda minha família pelo carinho e apoio constante durante esse processo. A meus avós, meu grande exemplo de persistência em todas as fases da minha vida. A meus pais que sempre me incentivaram a estudar e seguir em frente. A minha esposa pelo companheirismo. Ao meu filho pelo amor incondicional. AGRADECIMENTOSA toda minha família pela base dada durante todas as minhas conquistas.Ao meu orientador, Prof. Dr. José Carlos Nicolau, a quem considero exemplo profissional, por toda dedicação para minha formação e de tantos outos alunos.Aos médicos assistentes da Unidade Coronaria do Instituto do Coração -

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Continuous Glucose Monitoring: 40 Years, What We′ve Learned and What’s Next

Gifford¹

2013

ChemPhysChem

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After 40 years of research and development, today continuous glucose monitoring (CGM) is demonstrating the benefit it provides for millions with diabetes. To provide in vivo accuracy, new permselective membranes and mediated systems have been developed to prevent enzyme saturation and to minimize interference signals. Early in vivo implanted sensor research clearly showed that the foreign body response was a more difficult issue to overcome. Understanding the biological interface and circumventing the inflammatory response continue to drive development of a CGM sensor with accuracy and reliability performance suitable in a closed-loop artificial pancreas. Along with biocompatible polymer development, other complimentary algorithm and data analysis techniques have improved the performance of commercial systems significantly. For example, the mean average relative difference of Dexcom's CGM system improved from 26 to 14% and its use-life was extended from 3 to 7 d. Significant gains in usability, including size, flexibility, insertion, calibration, and data interface, have been incorporated into new generations of commercial CGM systems. Besides Medtronic, Dexcom, and Abbott, other major players are also investing in CGM. Becton Dickinson is conducting clinical trials with an optical galactose glucose binding system. Development of fully implanted sensor systems fulfills the desire for a discreet, reliable CGM system. Research continues to find innovative ways to help make living with diabetes easier and more normal, and new segments are being pursued (intensive care unit, surgery, behavior modification) in which CGM is being utilized.

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Glucose Control in Acute Myocardial Infarction: A Pilot Randomized Study Controlled by Continuous Glucose Monitoring System Comparing the Use of Insulin Glargine with Standard of Care

Cited by 9 publications

References 25 publications

Glycemic Variability Determined by Continuous Glucose Monitoring System Predicts Left Ventricular Remodeling in Patients With a First ST-Segment Elevation Myocardial Infarction

Glycemic Variability Determined by Continuous Glucose Monitoring System Predicts Left Ventricular Remodeling in Patients With a First ST-Segment Elevation Myocardial Infarction

Uso do inibidor da DPP4 em pacientes portadores de diabetes tipo 2 com infarto agudo do miocárdio: efeitos na função plaquetária

Continuous Glucose Monitoring: 40 Years, What We′ve Learned and What’s Next

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