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Author Notes:

Corresponding author: Kara A. Nerenberg, recreate@phri.ca

K.A.N., A.G., D.X., S.R.M., R.D., S.Y., and H.C.G. designed the study.

K.A.N., D.X., A.S., S.R.M., and R.D. acquired the data.

J.N. performed statistical analysis.

K.A.N., A.G., J.N., and H.C.G. performed analysis and interpreted the data.

K.A.N., A.G., M.K., and H.C.G. developed the insulin algorithms.

All authors had an active role in manuscript preparation.

K.A.N. was the guarantor.

K.A.N. received a salary from the Canadian Institutes of Health Research RCT Mentorship award under supervision from H.C.G.

S.R.M. received consulting fees from sanofi-aventis, and his institution received research grants from sanofi-aventis.

M.K. is a consultant for Medtronic MiniMed and sanofi-aventis.

H.C.G. holds the Population Health Research Institute Chair in Diabetes (established by a donation from sanofi-aventis). He received consulting and lecture fees from sanofi-aventis, the manufacturer of glulisine and glargine, and his institution received grants from sanofi-aventis.

No other potential conflicts of interest relevant to this article were reported.

Subjects:

Research Funding:

This trial was funded by an unrestricted grant by sanofi-aventis. sanofi-aventis had no role in the design and conduct of the trial; in site monitoring; in data collection, analysis, and interpretation; or in preparation of the manuscript.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Endocrinology & Metabolism
  • ENDOCRINOLOGY & METABOLISM
  • ACUTE MYOCARDIAL-INFARCTION
  • RANDOMIZED CONTROLLED-TRIAL
  • DIABETES-MELLITUS
  • ARTERY-DISEASE
  • INSULIN THERAPY
  • EURO HEART
  • MORTALITY
  • INFUSION
  • RISK
  • HYPERGLYCEMIA

Piloting a Novel Algorithm for Glucose Control in the Coronary Care Unit The RECREATE (REsearching Coronary REduction by Appropriately Targeting Euglycemia) trial

Tools:

Journal Title:

Diabetes Care

Volume:

Volume 35, Number 1

Publisher:

, Pages 19-24

Type of Work:

Article | Final Publisher PDF

Abstract:

OBJECTIVE - Elevated glucose levels are common after an acute myocardial infarction (AMI) and increase the risk of death. Prior trials of glucose control after AMI have been inconsistent in thei r ability to lower glucose levels and have reportedmixed effects on mortality. We developed a paper-based glucose-lowering algorithm and assessed its feasibility and safety in the setting of AMI. RESEARCH DESIGN AND METHODS - A total of 287 participants with an acute ST segment elevation myocardial infarction (STEMI) and a capillary glucose level ≥8.0 mmol/L were randomly allocated to glucose management with intravenous glulisine insulin using this algorithmin the coronary care unit (CCU), followed by once-daily subcutaneous insulin glargine for 30 days versus standard glycemic approaches. The primary outcome was a difference inmean glucose levels at 24 h. Participants were followed for clinical outcomes through 90 days. RESULTS - At 24 h, themean glucose level was 1.41mmol/L (95%CI 0.69-2.13) lower in the insulin (6.53 vs. 7.94mmol/L). Differences in glucose levels weremaintained at 72 h and 30 days. A total of 22.7% of the insulin group versus 4.4% of the standard group had biochemical hypoglycemia (with neither signs nor symptoms) in the CCU because of lower glycemic goals. However, there were no differences in symptomatic hypoglycemia or clinical outcomes between the groups. CONCLUSIONS - A paper-based insulin algorithm targeting glucose levels of 5.0-6.5 mmol/L (90-117 mg/dL) can be feasibly implemented in the CCU. A cardiovascular outcomes trial using this approach can determine whether targeted glucose lowering improves patient outcomes.

Copyright information:

© 2012 by the American Diabetes Association.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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