Citation: Diabetic Medicine, March 2014, vol./is. 31/(77),
Author: Hegde P.; Ormsby N.; Kaivani F.M.; Bowen-Jones D.
Abstract: Introduction: Hyperglycaemia is associated with higher mortality in patients with acute
coronary syndrome (ACS). Conflicting evidence from studies in this area has resulted in a
lack of clarity over optimal treatment regimes. Aim: To quantify how this lack of
evidence and the inconclusive guidelines impact the management of hyperglycaemia.
Methods: This is a retrospective case notes analysis of 50 randomly selected patients
between October 2011 and March 2012 at Wirral University Teaching Hospital against
the NICE guidelines. Results: Of the 50 patients (32 male, 18 female), average age 74.5
years,43patients (86%) were known to have diabetes and seven (4%) were not at the time
of admission. Of the 43 patients 14 were on diet, 22 were on oral hypoglycaemic agents
and seven were insulin treated. Thirty-one patients had admissionblood glucose above
11mmol/l and 17 did not have any treatment within 48h despite having hyperglycaemia.
Five patients received glucose potassium insulin infusion and six had their usual
treatment. Only34patients had blood glucose chart and regular glucose monitoring. For 22
patients blood glucose was out of the target range in the first 48h. Only 10 patients were
referred to the diabetes team during their admission. Conclusion: Our audit demonstrates
the lack of knowledge and inconsistency in managing hyperglycaemia in patients with
ACS. This clearly prompts the need for a robust and comprehensive guideline in
managing this area. Current NICE guidelines are unhelpful.
