Glucose control in acute myocardial infarction: a pilot randomized study controlled by continuous glucose monitoring system comparing the use of insulin glargine with standard of care.

BACKGROUND: This pilot study aimed to verify if glycemic control can be achieved in type 2 diabetes patients after acute myocardial infarction (AMI), using insulin glargine (iGlar) associated with regular insulin (iReg), compared with the standard intensive care unit protocol, which uses continuous insulin intravenous delivery followed by NPH insulin and iReg (St. Care). PATIENTS AND METHODS: Patients (n=20) within 24 h of AMI were randomized to iGlar or St. Care. Therapy was guided exclusively by capillary blood glucose (CBG), but glucometric parameters were also analyzed by blinded continuous glucose monitoring system (CGMS). RESULTS: Mean glycemia was 141±39 mg/dL for St. Care and 132±42 mg/dL for iGlar by CBG or 138±35 mg/dL for St. Care and 129±34 mg/dL for iGlar by CGMS. Percentage of time in range (80-180 mg/dL) by CGMS was 73±18% for iGlar and 77±11% for St. Care. No severe hypoglycemia (≤40 mg/dL) was detected by CBG, but CGMS indicated 11 (St. Care) and seven (iGlar) excursions in four subjects from each group, mostly in sulfonylurea users (six of eight patients). CONCLUSIONS: This pilot study suggests that equivalent glycemic control without increase in severe hyperglycemia may be achieved using iGlar with background iReg. Data outputs were controlled by both CBG and CGMS measurements in a real-life setting to ensure reliability. Based on CGMS measurements, there were significant numbers of glycemic excursions outside of the target range. However, this was not detected by CBG. In addition, the data indicate that previous use of sulfonylurea may be a potential major risk factor for severe hypoglycemia irrespective of the type of insulin treatment.

Contribuiçäo do monitor de eventos no diagnóstico de sintomas / The contribution of the loop memory ECG recorder to the diagnosis of symptoms

OBJETIVO: A avaliar o poder de contribuiçäo do monitor de enventos sintomáticos no esclarecimento de sintomas. MÉTODOS: Foram estudados 64 pacientes encaminhados para esclarecimento de sintomas e que já haviam sido submetidos à gravaçäo com Holter. Foram monitorizados, durante 15 dias, com gravador com memória circular com capacidade de registrar uma derivaçäo do ECG (CM5), antes e após ativado pelo paciente. Na vigência de sintomas, o paciente acionava um comando do gravador que provocava a retençäo do sinal do ECG, que era, posteriormente, transmitido a uma central via telefone. Resultados: Em dois pacientes näo foi possível a realizaçäo completa da monitorizaçäo, nos restantes, sintomas que motivaram a indicaçäo do exame foram: palpitaçöes ( 67,7 "por cento"), tonturas (32,3 "por cento"), síncopes(29 "por cento") e outros (30,6 "por cento"). Em 85,5 "por cento" dos pacientes houve relato de sintomas, sendo que em 62,2 "por cento" houve registros de alteraçöes eletrocardiográficas, relacionadas aos sintomas: taquicardia sinusal, 45,5 "por cento"; extra-sístoles, 30,3 "por cento"; taquicardia supraventricualar, 21,2 "por cento"; 21,2 "por cento" taquicadia ventricular, 3 "por cento" e bloqueio atrioventricular, 3 "por cento". A primeira transmissäo motivada por sintomas ocorreu: 35,5 "por cento" no 1 primeiro dia, 33,9 "por cento" do 2 "segundo" ao 5 "quinto", 12,9 "por cento" do 6 "sexto" ao 10 "decimo" e 3,2 "por cento" 11"décimo primeiro" ao 15 "décimo quinto". Nos pacientes onde a gravaçäo com Holter näo permitiu esclarecimentos, o gravador de eventos registrou sintomas em 35,5 "por cento". CONCLUSÄO: Trata-se de métodos bem aceito pelos pacientes e capaz de produzir aumento sgificativo no esclarecimento de síntomas em relaçäo ao Holer.