Glucocardio monitoring in patients with diabetes mellitus type 2 and acute myocardial infarction in the conditions of ICU
AbstractAim. To evaluate the effect of hyperglycemia, hypoglycemia and dysglycemia on the course and prognosis of acute myocardial infarction in patients with diabetes mellitus type 2.
Methods. All patients admitted to the ICU with symptoms of acute myocardial infarction and diabetes mellitus type 2 in history, after signing an informed consent to participate in the study, performed the clinical examination, laboratory and instrumental examinations, including clinical and biochemical analyzes of blood, determination cardiac enzymes hsCRP, markers of oxidative stress (MDA, SOD, GP) in dynamics, glycated hemoglobin, glucocardiomonitoring within 24 hours. Filled questionnaire to identify prior hypoglycemia. Formed a preliminary prognosis of AMI. AMI treatment is carried out in accordance with the standard protocol. If there are indications CAG and revascularization. Hypoglycemic therapy in some patients with persistent hyperglycemia, 10 mmol/l or more within the first 24 hours is represented by a continuous intravenous infusion of insulin (NVII) based on indicators of glucose, according to the protocol presented in algorithms specialized medical care for patients with diabetes mellitus (5th edition, 2011). Second subgroup of patients received conventional therapy. When taking office in/infusion is replaced by s/c insulin injection to stabilize glycemia at 8–11 mmol/l, after which patients can translate into different schemes hypoglycemic therapy (OADs, combination therapy: PTS + insulin, insulin). Before discharge from the Department (21 days) for all patients performed: blood sugar control, echocardiography, ECG dynamics glucocardio monitoring, evaluation of oxidative stress markers and hsCRP. Patients with diabetes mellitus type 2 and myocardial infarction who died before admission to the ICU, post-mortem and then receiving a liver slices on a freezing microtome stained with Sudan to assess glycogen content and addressing the issue of the relationship developed myocardial infarction prior hypoglycemia.
Currently being recruited patients in both study groups.
Conclusions. Сonducting simultaneous glucocardiomonitoring in patients with diabetes mellitus type 2 and acute myocardial infarction allows us to trace the relationship between glycemic variability and changes in the electrocardiogram in acute myocardial infarction, to assess the impact of different variants of glucose-lowering therapy for acute myocardial infarction in patients with diabetes mellitus type 2 and helps in drafting recommendations for the safe strategy is not hypoglycemic therapy during acute myocardial infarction and the next 3 weeks.
Keywords:glucocardio monitoring, diabetes mellitus type 2, acute myocardial infarction, ICU