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Hyperglycaemia in acute coronary syndromes overview

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Hyperglycaemia in acute coronary syndromes

About

What is covered

This pathway covers the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours in adults admitted to hospital for acute coronary syndrome (ACS). Hyperglycaemia is common in people admitted to hospital for ACS and is a powerful predictor of poorer survival and increased risk of complications while in hospital. Hyperglycaemia after an ACS is also associated with an increased risk of developing type 2 diabetes.
This pathway covers:
  • the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours of admission for ACS in people with diagnosed diabetes and people without known diabetes
  • tests for diabetes, lifestyle advice and ongoing monitoring for people without known diabetes.
A wide range of national guidance is available for the care of people with diabetes in hospital and this is relevant to patients with ACS. For example, guidance from the NHS Institute for Innovation and Improvement recommends that all patients with ACS and known diabetes are referred to the inpatient diabetes team.

Updates

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on the following topic.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Updates to this pathway

10 June 2014 Minor maintenance update.
20 December 2013 Minor maintenance update.
9 July 2013 Minor maintenance update.
8 February 2013 Minor maintenance update.

Short Text

Management of hyperglycaemia in adults with acute coronary syndromes

What is covered

This pathway covers the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours in adults admitted to hospital for acute coronary syndrome (ACS). Hyperglycaemia is common in people admitted to hospital for ACS and is a powerful predictor of poorer survival and increased risk of complications while in hospital. Hyperglycaemia after an ACS is also associated with an increased risk of developing type 2 diabetes.
This pathway covers:
  • the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours of admission for ACS in people with diagnosed diabetes and people without known diabetes
  • tests for diabetes, lifestyle advice and ongoing monitoring for people without known diabetes.
A wide range of national guidance is available for the care of people with diabetes in hospital and this is relevant to patients with ACS. For example, guidance from the NHS Institute for Innovation and Improvement recommends that all patients with ACS and known diabetes are referred to the inpatient diabetes team.

Sources

The NICE guidance that was used to create the pathway.
Hyperglycaemia in acute coronary syndromes. NICE clinical guideline 130 (2011)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on the following topic.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Updates to this pathway

10 June 2014 Minor maintenance update.
20 December 2013 Minor maintenance update.
9 July 2013 Minor maintenance update.
8 February 2013 Minor maintenance update.

Supporting information

Glossary

A blood glucose level above 11 mmol/litre.
An intravenous infusion of insulin and glucose with or without potassium.

Paths in this pathway

Pathway created: October 2011 Last updated: February 2016

© NICE 2016

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