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An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS

Maggie S Hammersley, Gerry Rayman, Peter Winocour, Clive Weston Orcid Logo, John Birkhead, On Behalf Of The Titan-ACS Steering Group

British Journal of Diabetes, Volume: 15, Issue: 4, Start page: 173

Swansea University Author: Clive Weston Orcid Logo

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DOI (Published version): 10.15277/bjdvd.2015.041

Abstract

Aim. To assess the safety and efficacy of a variable rate intravenous insulin infusion to lower blood glucose (BG) in patients presenting with acute coronary syndrome and hyperglycaemia.Methods. We evaluated the response over 24 hours of a variable rate insulin infusion with 5% dextrose and potassiu...

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Published in: British Journal of Diabetes
ISSN: 1474-6514 1753-4305
Published: 2015
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URI: https://cronfa.swan.ac.uk/Record/cronfa23733
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2017-01-30T16:55:40.3726942</datestamp><bib-version>v2</bib-version><id>23733</id><entry>2015-10-13</entry><title>An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS</title><swanseaauthors><author><sid>df85e4e0e139d0f46eb683174eba98a9</sid><ORCID>0000-0002-8995-8199</ORCID><firstname>Clive</firstname><surname>Weston</surname><name>Clive Weston</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2015-10-13</date><deptcode>PMSC</deptcode><abstract>Aim. To assess the safety and efficacy of a variable rate intravenous insulin infusion to lower blood glucose (BG) in patients presenting with acute coronary syndrome and hyperglycaemia.Methods. We evaluated the response over 24 hours of a variable rate insulin infusion with 5% dextrose and potassium chloride (40 mEq/l), to control hyperglycaemia in 776 patients with an admission BG &#xF0B3; 10 mmol/l in 36 UK hospitals. Patients had either ST segment elevation or non-ST segment elevation myocardial infarction and the study included both patients with or without a diagnosis of diabetes. We measured blood glucose, initially hourly, and serum potassium at admission, and 24 hours and at the time of major arrhythmias. We measured survival to 30 days.Results. Median admission BG was 13.4 mmol/l (interquartile range 11.7, 18). At 6 hours BG was 8.0 mmol/l (6.2, 10.8), and at 20-24 hours was 8.3 mmol/l (6.5, 11.0). Hypokalaemia due to the infusion was not observed. Hypoglycaemia (BG &lt;3 mmol/l) occurred in 4.1% patients, and most frequently (8.6%) in the lowest weight quartile, adjusted odds ratio 3.91, p=0.008. 30-day survival was not adversely affected by the occurrence of hypoglycaemia. Patients in the highest weight quartile were more likely to have glucose in the upper quartile, &gt;10.8 mmol/l at 6 hours; adjusted odds ratio 1.82, p=0.011. Conclusions. This insulin regimen was safe and effective with low rates of hypoglycaemia and no excess mortality in the hypoglycaemic sub-group. Further adjustments are required for those in the lowest and highest quartiles of weight.</abstract><type>Journal Article</type><journal>British Journal of Diabetes</journal><volume>15</volume><journalNumber>4</journalNumber><paginationStart>173</paginationStart><publisher/><issnPrint>1474-6514</issnPrint><issnElectronic>1753-4305</issnElectronic><keywords>Hyperglycaemia; insulin; acute coronary syndrome</keywords><publishedDay>30</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2015</publishedYear><publishedDate>2015-09-30</publishedDate><doi>10.15277/bjdvd.2015.041</doi><url>http://bjdvd.co.uk/index.php/bjdvd/article/view/96/209</url><notes></notes><college>COLLEGE NANME</college><department>Medicine</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PMSC</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2017-01-30T16:55:40.3726942</lastEdited><Created>2015-10-13T13:13:42.7649707</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Maggie S</firstname><surname>Hammersley</surname><order>1</order></author><author><firstname>Gerry</firstname><surname>Rayman</surname><order>2</order></author><author><firstname>Peter</firstname><surname>Winocour</surname><order>3</order></author><author><firstname>Clive</firstname><surname>Weston</surname><orcid>0000-0002-8995-8199</orcid><order>4</order></author><author><firstname>John</firstname><surname>Birkhead</surname><order>5</order></author><author><firstname>On Behalf Of The</firstname><surname>Titan-ACS Steering Group</surname><order>6</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2017-01-30T16:55:40.3726942 v2 23733 2015-10-13 An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS df85e4e0e139d0f46eb683174eba98a9 0000-0002-8995-8199 Clive Weston Clive Weston true false 2015-10-13 PMSC Aim. To assess the safety and efficacy of a variable rate intravenous insulin infusion to lower blood glucose (BG) in patients presenting with acute coronary syndrome and hyperglycaemia.Methods. We evaluated the response over 24 hours of a variable rate insulin infusion with 5% dextrose and potassium chloride (40 mEq/l), to control hyperglycaemia in 776 patients with an admission BG  10 mmol/l in 36 UK hospitals. Patients had either ST segment elevation or non-ST segment elevation myocardial infarction and the study included both patients with or without a diagnosis of diabetes. We measured blood glucose, initially hourly, and serum potassium at admission, and 24 hours and at the time of major arrhythmias. We measured survival to 30 days.Results. Median admission BG was 13.4 mmol/l (interquartile range 11.7, 18). At 6 hours BG was 8.0 mmol/l (6.2, 10.8), and at 20-24 hours was 8.3 mmol/l (6.5, 11.0). Hypokalaemia due to the infusion was not observed. Hypoglycaemia (BG <3 mmol/l) occurred in 4.1% patients, and most frequently (8.6%) in the lowest weight quartile, adjusted odds ratio 3.91, p=0.008. 30-day survival was not adversely affected by the occurrence of hypoglycaemia. Patients in the highest weight quartile were more likely to have glucose in the upper quartile, >10.8 mmol/l at 6 hours; adjusted odds ratio 1.82, p=0.011. Conclusions. This insulin regimen was safe and effective with low rates of hypoglycaemia and no excess mortality in the hypoglycaemic sub-group. Further adjustments are required for those in the lowest and highest quartiles of weight. Journal Article British Journal of Diabetes 15 4 173 1474-6514 1753-4305 Hyperglycaemia; insulin; acute coronary syndrome 30 9 2015 2015-09-30 10.15277/bjdvd.2015.041 http://bjdvd.co.uk/index.php/bjdvd/article/view/96/209 COLLEGE NANME Medicine COLLEGE CODE PMSC Swansea University 2017-01-30T16:55:40.3726942 2015-10-13T13:13:42.7649707 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Maggie S Hammersley 1 Gerry Rayman 2 Peter Winocour 3 Clive Weston 0000-0002-8995-8199 4 John Birkhead 5 On Behalf Of The Titan-ACS Steering Group 6
title An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS
spellingShingle An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS
Clive Weston
title_short An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS
title_full An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS
title_fullStr An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS
title_full_unstemmed An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS
title_sort An evaluation of the safety and efficacy of a variable rate intravenous insulin infusion in the management of hyperglycaemia in acute coronary syndrome: experience of the TITAN-ACS
author_id_str_mv df85e4e0e139d0f46eb683174eba98a9
author_id_fullname_str_mv df85e4e0e139d0f46eb683174eba98a9_***_Clive Weston
author Clive Weston
author2 Maggie S Hammersley
Gerry Rayman
Peter Winocour
Clive Weston
John Birkhead
On Behalf Of The Titan-ACS Steering Group
format Journal article
container_title British Journal of Diabetes
container_volume 15
container_issue 4
container_start_page 173
publishDate 2015
institution Swansea University
issn 1474-6514
1753-4305
doi_str_mv 10.15277/bjdvd.2015.041
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
url http://bjdvd.co.uk/index.php/bjdvd/article/view/96/209
document_store_str 0
active_str 0
description Aim. To assess the safety and efficacy of a variable rate intravenous insulin infusion to lower blood glucose (BG) in patients presenting with acute coronary syndrome and hyperglycaemia.Methods. We evaluated the response over 24 hours of a variable rate insulin infusion with 5% dextrose and potassium chloride (40 mEq/l), to control hyperglycaemia in 776 patients with an admission BG  10 mmol/l in 36 UK hospitals. Patients had either ST segment elevation or non-ST segment elevation myocardial infarction and the study included both patients with or without a diagnosis of diabetes. We measured blood glucose, initially hourly, and serum potassium at admission, and 24 hours and at the time of major arrhythmias. We measured survival to 30 days.Results. Median admission BG was 13.4 mmol/l (interquartile range 11.7, 18). At 6 hours BG was 8.0 mmol/l (6.2, 10.8), and at 20-24 hours was 8.3 mmol/l (6.5, 11.0). Hypokalaemia due to the infusion was not observed. Hypoglycaemia (BG <3 mmol/l) occurred in 4.1% patients, and most frequently (8.6%) in the lowest weight quartile, adjusted odds ratio 3.91, p=0.008. 30-day survival was not adversely affected by the occurrence of hypoglycaemia. Patients in the highest weight quartile were more likely to have glucose in the upper quartile, >10.8 mmol/l at 6 hours; adjusted odds ratio 1.82, p=0.011. Conclusions. This insulin regimen was safe and effective with low rates of hypoglycaemia and no excess mortality in the hypoglycaemic sub-group. Further adjustments are required for those in the lowest and highest quartiles of weight.
published_date 2015-09-30T03:28:04Z
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