Cardiovascular Diseases, Hyperglycemia, Myocardial Infarction
Conditions
Keywords
Clinical Trial, Insulin
Brief summary
Insulin will safely reduce glucose levels in patients with acute ST-elevation myocardial infarction and admission hyperglycemia.
Detailed description
Patients will be randomly assigned to either the control arm and will receive usual AMI care or the experimental arm, which will include routine AMI care as well as intensive therapy intervention. In addition to the capillary blood glucose measurements obtained to titrate insulin doses in the experimental arm patients, laboratory plasma glucose will be drawn in all patients at randomization, 10, 24, 48, and 72 hours post randomization, 7 days post randomization (or hospital discharge if that occurs first), and 30 days post randomization.
Interventions
DRUGglulisine insulin, glargine insulin
IV infusion of glulisine, SC injection of glargine
Sponsors
Population Health Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Both nondiabetic patients and patients with non-insulin-requiring type 2 diabetes mellitus admitted with a suspected AMI are eligible if they meet the following criteria: * Signs or symptoms of AMI with definite ECG changes, defined as persistent ST-segment elevation (\> or = than 1 mm)in two or more contiguous leads, or new left bundle branch block * Onset of symptoms within 24 hours before hospital presentation * Capillary blood glucose level on presentation \> or = 8.0 mmol/L (144 mg/dL)
Exclusion criteria
* Patient with conditions that REQUIRE the administration of insulin, including: * Type 1 diabetes mellitus, defined by a documented history of diabetes mellitus before the age of 30 * Type 2 diabetes mellitus that was treated with insulin prior to AMI presentation * Type 2 diabetes mellitus that is known to be very poorly controlled (e.g. admission capillary blood glucose \> 16.0 mmol/L (288 mg/dL)or marked elevation in glucose for which the site investigator plans to treat with insulin therapy) * A history of severe hypoglycemic episodes (defined as hypoglycemia with symptoms which the patient is unable to reverse without the assistance of another person) within the past two years * Known or suspected end-stage liver disease (due to the risk of hypoglycemia in the setting of liver dysfunction and consequent impaired regulation of glucose homeostasis) * Cardiogenic shock on admission (due to the inaccuracy of glucose meter readings) * Documented pregnancy * Any concomitant disease (e.g. cancer) that might limit life expectancy to less than 90 days * Anticipated poor adherence with study treatments or an other factor that might jeopardize 90-day follow-up (e.g. no fixed address, long distance to hospital, etc.) * Prior enrollment in this trial or current enrollment in another trial of ST-segment elevation myocardial infarction
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The 24-hour difference in mean glucose between the two study groups. | 24 hours |
Secondary
| Measure | Time frame |
|---|---|
| The difference in mean glucose level achieved at 30 days between study groups | 30 days |
| Nonfatal recurrent myocardial infarction, nonfatal stroke, or cardiovascular death (as a composite and as separate outcomes) | Discharge, 30 days, 90 days, 1 year |
| Rehospitalization for congestive heart failure | Discharge, 30 days, 90 days, 1 year |
| All cause mortality | Discharge, 30 days, 90 days, 1 year |
| Resuscitated cardiac arrest or life-threatening arrhythmia (as a composite and as separate outcomes) | Discharge, 30 days, 90 days, 1 year |
| The difference in mean glucose level achieved at 7 days or hospital discharge (whichever is first) | 7 days or discharge |
| Cardiac procedures | Discharge, 30 days, 90 days, 1 year |
| Rehospitalization for any cause | Discharge, 30 days, 90 days, 1 year |
| Symptomatic and severe hypoglycemic episodes | Discharge, 30 days, 90 days, 1 year |
| Hypokalemic episodes | Discharge |
| Cardiogenic shock | Discharge, 30 days, 90 days, 1 year |
Countries
Argentina, Canada, India
Outcome results
None listed