An observational study just out in the Archives of Internal Medicine found that among hyperglycemic patients admitted with MI (some known diabetics and some not) reductions in blood sugar level over the course of their hospitalization were associated with improved survival, whether associated with insulin treatment or spontaneous. We can conclude nothing about treatment of hyperglycemia based on this study. The lower mortality associated with decreasing blood sugar levels over the course of hospitalization could just as easily reflect declining insulin counter-regulatory stress hormones indicative of milder infarction as it could the effects of treatment. The authors, in the paper’s conclusion and a Medscape/Heartwire interview, were circumspect.
For patients with ACS and hyperglycemia, somewhere out there there’s an optimal glycemic target for insulin treatment. But as of early 2009 we still don’t know what it is. The AHA scientific statement is still the best document we have to guide us.