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Hyperglycaemia in acute coronary syndromes
Short Text
Introduction
This pathway covers the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours in people 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: management of hyperglycaemia in people with acute coronary syndromes. NICE clinical guideline 130 (2011)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Assessment tools
The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Audit support
Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Costing support
Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Slide sets
Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Pathway information
Information for patients and the public
NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on each of the following topics.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution – 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 someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Government. If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children.
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
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-singleSource guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeOngoing management of known diabetes
View the 'Diabetes overview' pathTests 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
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAdvice 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:
- healthy eating in line with the diet pathway and the NICE guideline on the secondary prevention of MI
- physical exercise in line with the physical activity pathway
- weight management in line with the diet pathway and the NICE guideline on the secondary prevention of MI
- smoking cessation in line with the smoking pathway
- alcohol consumption in line with the NICE guideline on the secondary prevention of MI.
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
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePaths in this pathway
Pathway created: October 2011 Last updated: October 2011
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