Management of hyperglycemia in acute coronary syndrome. Issues and solutions

The role of hyperglycemia as an independent predictor of adverse course and prognosis of acute coronary syndrome (ACS) in patients with diabetes mellitus (DM) and without it [1] can hardly be overestimated. This relationship is thoroughly covered in the literature [2-- 13], and the discussions on the subject are underway. A simple summation of risks results in higher than expected rates of morbidity and mortality from CAD in DM patients, demonstrating a direct effect of hyperglycemia on the atherosclerotic process [14--16]. It is worth noting that in patients without DM hyperglycemia is associated with worse clinical outcomes and higher mortality from all causes compared with patients suffering from diabetes mellitus [17--21]. Increased blood sugar levels at the time of admission are usually seen as a reaction to stress in acute condition, but in some cases may serve as a marker of an existing though not yet diagnosed type 2 diabetes or impaired glucose tolerance (IGT) [22]. According to observational studies, hyperglycemia occurs in 32--38% of patients in hospitals [23, 24], 41% of severe patients with acute coronary syndrome[25], 44% of patients with heart failure [25] and 80% of patients after coronary intervention [26, 27].