Role of Tight Glycemic Control during Acute Coronary Syndrome on CV Outcome in Type 2 Diabetes

Abstract

Both incidence and mortality of acute coronary syndrome (ACS) among diabetic patients are much higher than those among nondiabetics. Actually, there are many studies that addressed glycemic control and CV risk, whilst the literature on the role of tight glycemic control during ACS is currently poor. Therefore, in this review, we critically discussed the studies that investigated this specific topic. Hyperglycemia is implicated in vascular damage and cardiac myocyte death through different molecular mechanisms as advanced glycation end products, protein kinase C, polyol pathway flux, and the hexosamine pathway. Moreover, high FFA concentrations may be toxic in acute ischemic myocardium due to several mechanisms, thus leading to endothelial dysfunction. A reduction in free fatty acid plasma levels and an increased availability of glucose can be achieved by using a glucose-insulin-potassium infusion (GIKi) during AMI. The GIKi is associated with an improvement of either long-term prognosis or left ventricular mechanical performance. DIGAMI studies suggested blood glucose level as a significant and independent mortality predictor among diabetic patients with recent ACS, enhancing the important role of glucose control in their management. Several mechanisms supporting the protective role of tight glycemic control during ACS, as well as position statements of Scientific Societies, were highlighted.

Diabetes mellitus exacerbates post‐myocardial infarction heart failure by reducing sarcolipin promoter methylation

“…One of our previous studies has also established the association between impaired cardiac functions and uncontrolled sustained hyperglycaemia in experimental diabetes animal models 4 . Glycaemic control improved the long‐term outcomes and LV mechanical performance of patients with acute coronary syndrome 25 . In this study, our population analysis suggested that HbA1c% was significantly associated with LV systolic dysfunctions in STEMI patients.…”

“…4 Glycaemic control improved the long-term outcomes and LV mechanical performance of patients with acute coronary syndrome. 25 In this study, our population analysis suggested that HbA1c% was significantly associated with LV systolic dysfunctions in STEMI patients. Moreover, worse LV systolic functions were identified in diabetic MI animals compared with non-diabetic MI animals.…”

The Effect of Glycemic Control on Endothelial and Cardiac Dysfunction Induced by Red Blood Cells in Type 2 Diabetes

“…As mentioned, glycemic control has not convincingly shown a benefit in the development of cardiovascular complications and mortality. The role of glycemic control during acute myocardial infarction and the subsequent complications in the clinical setting is different, however, and poorly characterized (Sasso et al, 2018). Increased levels of glucose at admission in patients with T2DM are associated with greater mortality risk (Kosiborod et al, 2005).…”

The Successful Rapid Adjustment of Blood Glucose in a Patient With Acute Coronary Syndrome, Renal Insufficiency, and Diabetes: A Case Report of Management Coordinated by Clinical Pharmacists and Clinicians

“…About half of the T2D patients have microvascular complications, and about a quarter of patients with T2D have developed macrovascular complications (Litwak et al, 2013). Hyperglycemia induced superoxide overproduction by the mitochondrial electron transport chain via polyol pathway flux, advanced glycation end products, protein kinase C, and the hexosamine pathway is the main reason that T2D is implicated in vascular damage and cardiac myocyte death (Sasso et al, 2018). Several studies suggested that diabetes could be an independent predictor of new cardiovascular events (Sasso et al, 2018;Avogaro et al, 2019).…”

“…Hyperglycemia induced superoxide overproduction by the mitochondrial electron transport chain via polyol pathway flux, advanced glycation end products, protein kinase C, and the hexosamine pathway is the main reason that T2D is implicated in vascular damage and cardiac myocyte death (Sasso et al, 2018). Several studies suggested that diabetes could be an independent predictor of new cardiovascular events (Sasso et al, 2018;Avogaro et al, 2019). In-hospital appropriate glucose control has a neutral effect on mortality after ACS (Avogaro et al, 2019).…”