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Hyperglycaemia in acute coronary syndromes

Short Text

Management of hyperglycaemia in adults with acute coronary syndromes

Introduction

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.

Source guidance

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

Successful effective interventions library details

Implementation

Commissioning

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.

Education and learning

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.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

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.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

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.

Patient admitted for acute coronary syndrome

Patient admitted for acute coronary syndrome

Managing hyperglycaemia within 48 hours of acute coronary syndrome

Managing hyperglycaemia within 48 hours of acute coronary syndrome

Managing hyperglycaemia within 48 hours of acute coronary syndrome

Manage hyperglycaemia by keeping blood glucose levels below 11.0 mmol/litre while avoiding hypoglycaemia. In the first instance, consider a dose-adjusted insulin infusion with regular monitoring of blood glucose levels.
Do not routinely offer intensive insulin therapy to manage hyperglycaemia unless clinically indicated.

Implementation tools

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Source guidance

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Ongoing management of known diabetes

View the 'Diabetes overview' path

Tests for patients without known diabetes

Tests for patients without known diabetes

Tests for patients without known diabetes

Offer tests for:
  • HbA1c levels before discharge and
  • fasting blood glucose levels no earlier than 4 days after the onset of acute coronary syndrome.
These tests should not delay discharge.
Do not routinely offer oral glucose tolerance tests if HbA1c and fasting blood glucose levels are within the normal range.

Source guidance

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Advice and ongoing monitoring for patients without known diabetes

Advice and ongoing monitoring for patients without known diabetes

Advice and ongoing monitoring for patients without known diabetes

Offer lifestyle advice on the following:
Advise patients that they:
  • are at increased risk of developing type 2 diabetes
  • should consult their GP if they experience the following symptoms:
    • frequent urination
    • excessive thirst
    • weight loss
    • fatigue
  • should be offered tests for diabetes at least annually.
Inform GPs that they should offer at least annual monitoring of HbA1c and fasting blood glucose levels.

Source guidance

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Patient experience in adult NHS services pathway

View the 'Patient experience in adult NHS services overview' path

Paths in this pathway

Pathway created: October 2011 Last updated: December 2013

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.

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