In a 40-center study of 7820 patients with hyperglycemia on admission, reducing glucose levels below 110 mg/dL increased the odds of survival by 2.1-, 5.3-, 6.9-, and 13.0-fold relative to glucose levels of 110 to <140, 140 to <170, and 170 to <200, and 200 or greater mg/dL, respectively.
“Although we had somewhat limited data regarding the intensity of insulin administration, our findings suggest that insulin therapy per se is not independently associated with a survival advantage,” Dr. Mikhail Kosiborod, from Saint Luke’s Hospital, Kansas City, Missouri, and co-researchers point out.
The study participants were hospitalized for an acute MI between 2000 and 2005. The subjects were divided into groups based on their postadmission glucose level and on whether they received insulin therapy.
As noted, on propensity-matched analysis no significant difference in mortality rates was seen between insulin-treated and non-insulin-treated patients in any of the five glucose level groups.
The results suggest that it does not matter how glucose normalization is achieved, just that it is accomplished, the researchers state.
Data from randomized trials is now needed to confirm the benefits of a target-driven glucose lowering strategy in hospitalized MI patients with hyperglycemia, the authors conclude.
Arch Intern Med 2009;169:438-446.