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Sensor-augmented insulin pump therapy to treat hyperglycemia at the coronary care unit: a randomized clinical pilot trial.

BACKGROUND
The relationship between admission hyperglycemia and adverse outcome in myocardial infarction has been shown consistently. However, achieving and maintaining normoglycemia in ST elevated myocardial infarction (STEMI) patients has proven difficult. This study aimed to investigate the efficacy of sensor-augmented insulin pump (SAP) therapy to treat hyperglycemia.


METHODS
In a randomized controlled pilot trial, we assigned 20 patients, 30-80 years old, admitted with STEMI and hyperglycemia (>or=140 mg/dL) to receive either 48 h of strict glycemic control with an subcutaneous insulin pump augmented with a continuous glucose monitor (SAP group) or to treatment according to standard practice (Control group) with glucose measured by blinded continuous glucose monitoring. The main outcome measure was proportion of time spent in hyperglycemia.


RESULTS
The median treatment time was 47.0 h (interquartile range [IQR], 46.2-48.0 h) in the SAP group and 44.6 h (IQR, 22.0-48.6 h) in the Control group. The median proportion of time >or= 140 mg/dL was 14.6% (IQR, 10.5-18.5%) in the SAP group and 36.3% (IQR, 26.0-80.4%) in the control group (P = 0.006). The proportion of time <or= 70 mg/dL was 8.9% (IQR, 8.3-12.5%) in the SAP group versus 0% (IQR, 0-2%) in the Control group (P < 0.001). Plasma glucose decreased significantly in the SAP group compared to the Control group (P = 0.025).


CONCLUSIONS
SAP therapy is effective in reducing hyperglycemia in STEMI patients on the coronary care unit. This is accompanied by a small but significant increase in hypoglycemia. Although a promising tool for in-hospital hyperglycemia therapy, SAP needs improvement before continuing to large-scale randomized controlled trials.