Myocardial infarction and type II diabetes - preferential treatment for high risk patients?*

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Abstract
Objectives: To compare variability of blood glucose concentration in patients with type II diabetes with (cases) and without (controls) myocardial infarction. A secondary objective was identification of predictive factors for higher blood glucose on discharge from hospital. Design: A retrospective matched case–control study. Participants: Medical notes of 101 type II diabetic patients admitted with a myocardial infarction (MI) and 101 type II diabetic patients (controls) matched on gender and age with no MI were reviewed. Blood glucose concentrations over two consecutive 48‐h periods were collected. Demographic data and therapy on admission/discharge were also collected. Results: Patient characteristics were comparable on recruitment excluding family history of cardiovascular disease (P=0·003), dyslipidaemia (P=0·004) and previous history of MI (P=0·007). Variability of blood glucose in cases was greater over the first 48 h compared with the second 48 h (P=0·03), and greater when compared with controls over the first 48 h (P=0·01). Cases with blood glucose on discharge >8·2 mmol / L (n=45) were less likely to have a history of previous MI (P=0·04), ischaemic heart disease (P=0·03) or hypertension (P=0·02). Conclusions: Type II diabetics with an MI have higher and more variable blood glucose concentrations during the first 48 h of admission. Only cardiovascular ‘high risk‘ patients had target blood glucose set on discharge. The desirability of all MI patients with diabetes, having standardized‐glucose infusions to reduce variability of blood glucose, should be evaluated in a randomized controlled trial.

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