Your browser doesn't support javascript.
loading
Intensive treatment of hyperglycemia in the acute phase of myocardial infarction: the tenuous balance between effectiveness and safety - a systematic review and meta-analysis of randomized clinical trials
Negreiros, Paulo H; Bau, Adriana; Nadruz, Wilson; Coelho Filho, Otavio R; Matos-Souza, José Roberto; Coelho, Otavio R; Sposito, Andrei C; Carvalho, Luiz Sergio F.
Affiliation
  • Negreiros, Paulo H; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
  • Bau, Adriana; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
  • Nadruz, Wilson; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
  • Coelho Filho, Otavio R; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
  • Matos-Souza, José Roberto; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
  • Coelho, Otavio R; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
  • Sposito, Andrei C; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
  • Carvalho, Luiz Sergio F; State University of Campinas. Faculty of Medical Sciences. Cardiology Department. Campinas. BR
Rev. Assoc. Med. Bras. (1992) ; 65(1): 24-32, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-985013
Responsible library: BR1.1
ABSTRACT
SUMMARY INTRODUCTION In acute myocardial infarction (AMI), each 18 mg/dl (1 mmol/L) increment is associated with a 3% increase in mortality rates. All strategies applied for reducing blood glucose to this date, however, have not presented encouraging results. METHODOLOGY We searched the Medline (PubMed) and Cochrane Library databases for randomized clinical trials (RCTs) from 1995 to 2017 that used the intensive strategy or GIK therapy for blood glucose control during the acute stage of the AMI. We included eight studies. In order to identify the effects of GIK or insulin therapy, we calculated a overall risk ratio (RR) with meta-analysis of fixed and random effects models. A two-tail p-value of < 0.05 was considered statistically significant. RESULTS A total of 28,151 patients were included 1,379 intensively treated with insulin, 13,031 in GIK group, and 13,741 in the control group. The total mortality was 10.5% (n=2,961) and the RR of 1.03 [95%CI 0.96-1.10]; I2 = 31%; p = 0.41 for the combined intensive insulin plus GIK groups in comparison with the control group. In meta-regression analyses, intense reductions in blood glucose (> 36 mg/dL) in relation to the estimated average blood glucose (estimated by HbA1c) were associated with higher mortality, whereas lower reductions in blood glucose (< 36 mg/dL) were not associated with mortality. The lowering of blood glucose in the acute phase of MI compared with the average blood glucose was more effective around 18 mg/dL. CONCLUSION This meta-analysis suggests that there may be a tenuous line between the effectiveness and safety of reducing blood glucose in the acute phase of MI. The targets must not exceed a reduction greater than 36 mg/dL in relation to estimated average blood glucose.
RESUMO
RESUMO INTRODUÇÃO No infarto agudo do miocárdio (IAM), cada incremento de 18 mg/dl (1 mmol/L) se associa a um aumento de 3% na mortalidade. As estratégias de redução da glicemia tentadas até o momento, entretanto, não trouxeram resultados animadores. METODOLOGIA Foram pesquisadas nas bases de dados Medline (PubMed) e Cochrane Library os ensaios clínicos randomizados (ECRs) de 1995 a 2017 que utilizaram estratégia intensiva ou a terapia GIK no controle glicêmico durante a fase aguda do IAM. Foram incluídos oito estudos. Para identificar os efeitos da insulinoterapia ou da terapia GIK, calculamos um risco relativo geral (RR) com meta-análises de modelos de efeitos fixos e aleatórios. Um valor de p-bicaudal < 0,05 foi considerado estatisticamente significativo. RESULTADOS Foram incluídos 28.151 pacientes, sendo 1.379 no grupo de tratamento intensivo da glicemia, 13.031 no GIK e 13.741 no controle. A mortalidade total foi de 2.961 (10,5%), computando um risco relativo de 1,03 [95%CI 0,96-1,10]; I 2 = 31%; p = 0,41 para o grupo intensivo ou GIK contra o grupo conservador. Reduções intensas (> 36 mg/dL) em relação à glicemia estimada média se associaram à maior mortalidade, enquanto reduções menores não se associaram com seu incremento ou redução. A redução glicêmica na fase aguda em relação à glicemia estimada média foi mais efetiva e segura na faixa em torno de 18 mg/dL. CONCLUSÃO Esta meta-análise levanta a hipótese de haver um limite tênue entre efetividade e segurança para a redução glicêmica na fase aguda, sendo que os alvos não devem exceder uma redução maior do que 36 mg/dL de glicemia.
Subject(s)


Full text: Available Collection: International databases Health context: SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases Health problem: Cardiovascular Disease / Endocrine System Diseases / Ischemic Heart Disease Database: LILACS Main subject: Hyperglycemia / Hypoglycemic Agents / Insulin / Myocardial Infarction Type of study: Controlled clinical trial / Etiology study / Systematic review Limits: Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2019 Document type: Article Affiliation country: Brazil Institution/Affiliation country: State University of Campinas/BR

Full text: Available Collection: International databases Health context: SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases Health problem: Cardiovascular Disease / Endocrine System Diseases / Ischemic Heart Disease Database: LILACS Main subject: Hyperglycemia / Hypoglycemic Agents / Insulin / Myocardial Infarction Type of study: Controlled clinical trial / Etiology study / Systematic review Limits: Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2019 Document type: Article Affiliation country: Brazil Institution/Affiliation country: State University of Campinas/BR
...