بسم اللة الرحمن الرحيم
Outcomes of acute myocardial infarction in Type 2 diabetic Yemeni patients using different methods of treatment Dr Ahmed Al Qudaimi.MSc.MD.FAHA MESC.MEAPACI.MSCAI Assisst Professor of Medicine. Sana'a University. Interventional Cardiac Consultant. President of Yemeni Heart Association
Diabetes (DM) mellitus is a chronic disease that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Patient with type 2 DM have a two to four fold increase incidence of disease related to atheroma. ESC/AHA/a\ACC guidelines 2011
Objectives of the study: • Evaluation of the impact of IV continuous insulin infusion technique on the outcome of acute MI as compared to the sliding scale in diabetic patients. • Post MI surveillance of patients was also conducted over the next 12 months.
Design and Methodology: • Our study is a single-centre hospital based cohort prospective (interventional) study. • All of the studied patients were subjected to history, clinical evaluation, biochemical investigation. • ECG and Echocardiography were done for them. Interventional procedures were done for all of the patients such as PCI or CABG.
• Statistical analysis was done by SPSS system. • A total of 150 consecutive Yemeni patients were included in this study. One hundred (100) patients were diabetic and fifty (50) patients were control (non diabetic).
• The diabetic patients were treated by different methods of insulin treatment protocol, 50 patients were treated by insulin infusion therapy (IIT) and 50 patients were treated by sliding scale insulin (SSI) protocol. • Anti-ischemic treatment (medications) was given to all the cases and control groups.
Setting of the work: We recruited all patients admitted to the intensive care units (cardiac and non- cardiac) at Al-Thawra Teaching Hospital in Sana’a over 12 months (Jan 2007-Dec2010). Ethical clearance. Inclusion and exclusion criteria.
Results • Male predominance was evident in this study. Mean (±SD) Waist circumference (WC) was significantly higher in diabetic patients (95.4±15.2 cm) than in the control (90±13.3 cm) (p= 0.032).
Abdominal adiposity measured as, waist to height ratio (WHtR) was found to be more prevalent among diabetic patients (70%) compared to the control patients (44%), p= 0.0037. There was no significant difference between diabetic and non diabetic patients in regards to other cardiovascular risk factors.
The mean (±SD) admission blood glucose (ABG) level was significantly higher in the diabetic group (17.2±5.6 mmol/l) than in the control group, (6.9±1.3 mmol/l), p<0.0001. Also the mean (±SD) HbA1c% showed significantly higher value in the diabetic group (11.4±1.42 %) compared to the control group, (5.8±0.64 %), p=0.006.
Heart failure was noted to be more frequent among diabetics treated with (SSI), (34%) than in those treated with (IIT) (19.1%), p=0.01. Arrhythmia was less frequent among diabetics treated with IIT (12%), than those treated with SSI (20%), p=0.31.
â&#x20AC;˘ Recurrent chest pain found to be more frequent among diabetics treated with IIT (38%) than those treated with SSI (18%), p=0.04. â&#x20AC;˘ In contrast, stroke was found to be more frequent among SSI patients (20%) than IIT patients (0%), p<0.0001. As for mortality, it was noted to be more among SSI treated patients (20%) than IIT treated patients (6%), p=0.04.
Table (1): Baseline characteristics of diabetic and non diabetic groups at entry to the study
Variables
Diabetes (n=100)
Gender :Male
Control group(non diabetes) (n=50)
P-value
73 (73%)
38 (76%)
0.693
Age Mean (SD) year
58.5 (10.4)
59 (8.0 )
0.664
BMI kg/m2 Mean (SD)
30.7 (7.4)
33 (14.6)
0.199
WC (cm)Mean (SD)
95.4 (15.2)
89.9 (13.3)
0.032
Table (1) continued
SBP mmHg Mean (SD) DBP mmHg Mean (SD) Mean arterial blood pressure (MAP)Mean (SD)
139.4 (34.2) 84.3 (18.7) 102.71 (22.6)
146.0 (28.5) 86.0 (13.2) 106.0 (18.0)
0.245 0.575 0.370
Admission plasma Glucose (mmol/l)Mean (SD)
17.2 (5.6)
6.9 (1.3)
<0.0001
HbA1c% Mean (SD) CK_MB iu/l Mean (SD) Troponin iu/l Mean (SD) Typical chest pain (%)
11.4 (1.42) 251.2 (157.6)
5.8 (0.64) 346.5 (151.4)
0.006 0.001
4.3 (23.4) 99(99%)
3.5(13.1) 48(96%)
0.851 0.216
Kllip,s class(%) I II III IV
64(64%) 26(26%) 08(8%) 02(2%)
40(80%) 10(20%) 0.0 0.0
0.019 0.008
ECG changes STEMI(%) NSTEMI %o)
87(87%) 13(13%)
47(94%) 3(6%)
0.190 0.102
Smoking status 57(57%) Current smoker Ex-smoker16(16%) Non-smoker 27(27%)
24(48%) 14(28%) 12 (24%)
0.715 0.016
Table (1) continued Current khat chewer Occupation : i- Admnistrator /Professional ii-Business iii-NM+Mskilled iv-Partially skilled vUnemployed vi- retired
83(83%) 15 15 13 11 26 2
Lipids: Mean (SD) TC 5.8± (1.1) 1.7± (0.9) HDL-C LDL-C TG 5.9± (11.8) TC/HDL 2.7 ± (1.6) 4.4 ± (3.2)
37(74%)
<0.0001
3 5 4 14 16 0
0.005 0.025 0.549 0.123 0
5.4± (1.4) 1.2± (0.4) 3.6± (0.8) 2.2± (1.1) 5.7 ± (6.2)
0.037 <0.0001 0.049 0.030 0.105
Table (2); Prevalence of cardiovascular risk factors at the time of admission among diabetic and non-diabetic (control) patients. Variables
Diabetic patients (n=100)
Non-diabetic patients (n=50)
p-value
Age>50 year Obesity (BMI>30 Kg/m2 Abdominal adiposity (*WHtR>0.6)
83 (83%) 39 (39%)
47 (94%) 24(48%)
0.1 0.38
70 (70%)
22 (44%)
0.0037
Current smoking%
57 (57%)
24(48%)
0.38
Hypertension, (systolic 64 (64%) BP> 140 mmHg) Atherogenic lipid profile 84 (84%) (LDL-C >4.2 mmol/l and/or TC/HDL-C >4.0)
34(68%)
0.76
38 (76%)
0.34
Table (3): Initial presentation: Clinical features of AMI in diabetic and non-diabetic control patients:
Features
DM ( n=100)
Character of chest pain: Constricting (%)19 (19%) 18 (18%) Crushing (%) Burning (%) 32 (32%) Others (%)31 (31%) Arrhythmia Heart block (%) PVC (%)
18 (18%) 10 (10%)
Non-DM(n=50 )
P-value
7 (14%) 10 (20%) 19 (38%) 14 (28%)
0.019 0.131 0.043
6 (12%) 4 (8%)
0.345 0.691
CK-MB iu/l Mean (SD)
251.2 (1576)
346.5 (151.4)
0.001
Troponin iu/l Mean (SD) STEMI(%)
4.3 (23.4)
3.6 (13.1)
0.851
87 (87%)
47 (94%)
0.190
NSTEMI(%)
13 (13.0%)
3 (6.0%)
0.102
Killips(%) I II III IV
64 (64%) 26 (26%) 8 (8%) 2 (2%)
40 (80%) 10 (20%) 0 (0%) 0 (0%)
0.019 0.008 NS NS
SBP(mmHg)-MEAN (SD)
139.4 (34.2)
146.0 (28.5)
0.245
DBP(mmHg0 -MEAN (SD)
84.3 (18.7)
86.0 (13.2)
0.575
Table (3) continued MAB(mmHg)-MEAN
102.71 (22.6)
106.0 (18.0)
0.370
93.04 (2.951)
94.38 (2.884)
0.774
(SD) HR bpm-MEAN (SD)
Categories of HR bpm 34(34.0%) >100 53(53.0%) 60-100 13(13.0%) <60 TC(mmol/l)-Mean (SD) HDL(mmol/l)-Mean (SD) LDL(mmol/l)-
12(24.0%) 34(68.0%) 4(8.0%)
0.001 0.042 0.029
5.8 (1.1)
5.4 (1.4)
0.037
1.7 (0.9)
1.2 (0.4)
5.9 (11.8)
3.6 (0.8)
0.049
2.7 (1.6)
2.2 (1.1)
0.030
4.4 (3.2)
5.6 (6.2)
0.105
<0.0001
Mean( SD) TG(mmol/l)-Mean (SD) TC/HDL(mmol/l)Mean (SD)
Table (4): Echocardiography characterization of AMI in DM and Non-DM: Variables
DM(n=100)
N0N-DM (n=50)
P-value
Akinesia
32 (32%)
11 (22%)
0.165
Hypokinesia
84 (84%)
49 (98%)
.026
Dyskinesia
13 (13%)
4 (8%)
0.332
Aneurismal changes
8 (8%)
0.0
0.037
Mitral regurge
24(24.7%)
0(0.0%)
Non
VSD
2 (2%)
1.0 (2%)
0.564
Table (5): In hospital course of AMI in DM and Non- DM (7days): Variables
DM (n=100)
Non-DM (n=50 )
P- value
Heart Failure
26 (26%)
9 (18 %)
0.235
Arrhythmia
16 (16%)
7 (14%)
0.712
Recurrent chest pain
28 (28%)
9 (18%)
0.142
Stroke
10 (10%)
4 (8%)
0.646
Mortality in hospital
13 (13%)
4 (8%)
0.362
Table (6): In hospital course of AMI in diabetic patients treated either with insulin infusion protocol (group 1) or with sliding scale protocol (group 2) over (7 days): Variables
Insulin infusion group 1
Sliding scale group 2
P- value
(n=50)
(n=50)
Heart Failure%
9 (19.1%)
17 (34%)
0.099
Arrhythmia%
6 (12.0%)
10 (20.0%)
0.315
Recurrent chest pain%
19 (38.0%)
9 (18.0%)
0.044
Stroke%
0 (0%)
10 (20.0%)
<0.0001
Mortality in hospital%
3 (6.0%)
10 (20.0%)
0.037
Table (7): Coronary Angiography of the study groups: Variables
Group 1 (patients treated Group 2 (patients treated Group 3 (control by insulin infusion (n=50) by sliding scale) (n=50)
patients)(n=50)
Normal
1 (2%)
0.0
3 (6%)
Single vessel
26 (52%)
26 (52%)
19 (38%)
2-vessel
12 (24%)
11 (22%)
16 (32%)
Multivessel
8 (16%)
3 (6%)
8 (16%)
Left system
19 (38%)
17 (34%)
18 (36%)
Right system
9 (18%)
12 (24%)
6 (12%)
Right+Left system
19 (38%)
11 (22%)
22 (44%)
PCI
40 (80%)
36 (72%)
37 (74%)
CABG
7 (14%)
4 (8%)
8 (16%)
Table (8): Baseline clinical characteristics of diabetic patients treated with both insulin infusion (group 1) and sliding scale (group 2): Variables Duration of diabetic Mean(SD) Age: MEAN(SD) Gender(M/F)%
IV-insulin infusion (n=50) Group 1 13 (8.6)
Sliding scale (n=50) Group 2 13.03 (8.6)
0.004
58.4 (11.3)
58.5 (9.6)
0.962
35 (70.0%) Male15 (30.0%) Female
Killip's % I II III IV
31 (62%) 10 (20%) 7 (14%) 2 (4%)
38 (76.0%) 12 (24.0%)
33 (66%) 16 (32%) 1 (2%) 0.0 (0%)
P-value
0.725 0.564
0.803 0.239 0.034
Nil
BMI(kg/m2)(mmHg)- Mean (SD) SBP(mmHg)- Mean(SD)
30.7 (8.5)
30.7 (6.2)
0.998
142.6 (34.8)
136.3 (33.8)
0.362
DBP(mmHg)- Mean(SD)
84.4 (18.1)
84.3 (19.5)
0.983
HR b/m-Mean(SD)
94.76 (27.9)
91.32 (31.3)
0.563
Troponin iu/l- Mean(SD)
6.3 (3.3)
2.2 (2.3)
0.389
CK-MB iu/l- Mean(SD)
205.3 (144.2)
297 (158.4)
0.003
Table (8) continued
PG(mmol/l)- Mean(SD) 17.2 (5.6)
17.2 (5.6)
0.9
HbAc% Mean(SD)
10.3(1.11)
12.6(1.67)
0.6
Chest pain(%)
49 (98.0%)
50 (100.0%)
0.920
STEMI (%)
43 (86%)
44 (88%)
0.915
NSTEMI (%)
7 (14%)
2 (4%)
0.096
Arrhythmia (%)
6 (12.5%)
10 (20.0%)
1.000
Stress hyperglycemia
10 (20.0%)
2 (4%)
0.021
(%)
Table (9): Comparison of mean blood glucose concentration between diabetic patients treated with insulin infusion and sliding scale methods, at admission and during in hospital treatment of AMI: Variables
Insulin infusion(n=50)
Admission (pretreatment) 17.2(5.6) 15.6-18.8 plasma glucose
Sliding scale(ÂŤ=50)
P-value
17.3(5.6) 15.7-18.9
0.942
8.0 (1.5) 7.8-8.4
<0.0001
concentration (mmol/l): Mean (SD) 95% CI of mean
Average plasma glucose concentration during treatment (1-3 days)(mmol/l): Mean (SD) 95% CI of mean
5.1(o.7) 4.9-5.4
Table (10): Post MI Outcome at 3 months: Variables
Group 1(n=50)
Group 2(n=50)
Group 3(n=50)
p-value
Recurrent chest pain%
40%
21%
20%
0.02
FPG(mmol/l)- Mean(SD)
5.8 (0.45)
6.3 (0.74)
5.7 (0.9)
<0.0001 )
HbA1c%-Mean(SD) Echo-complications Aneurysm (%) Scaring (%) Rupture papillary muscles
6.0 (0.17)
6.2 (0.20)
5.3 (0.31)
<0.0001 )
6 (12.0%) 5 (10.0%) 10 (20.0%)
13 (26.0%) 13 (26.0%) 14 (28.0%)
7 (14%) 7 (14%) 7 (14%0
0.15 0.09 0.27
5.4 (0.5)
5.6 (0.4)
5.3 (0.5)
0.011
1.3 (0.20)
1.3 (0.2)
1.3 (0.14)
0.1
3.4 (0.3)
3.4 (0.34)
3.7 (0.32)
<0.0001
TG(mmol/l)-Mean(SD)
1.65 (0.2)
1.6 (0.24)
1.65 (0.20)
0.6
Need for readmission
5 (10.0%)
15 (30%)
6 (12%)
*0. 8
CV-mortality Heart failure
3 (6.0%) 5 (10%)
9 (18%) 12 (24%)
3 (6.0%) 6(12%)
*1. 0 *0. 8
(%) Lipid profiles TC(mmol/l)-Mean(SD) HDL(mmol/l)Mean(SD) LDL(mmol/l)- Mean(SD)
Table (11): Post MI Outcome at 6 months: Variables Recurrent chest pain-%
Group 1(n=50) 0
Group 2(n=50) 0
Group 3(n=50) 0
p-value 0
FPG(mmol/l)-Mean(SD)
5.5 (0.5)
6.0 (0.3)
5.4 (0.7)
<0.0001)
HbA1c%-Mean(SD) Echo-complications Aneurysm (%) Scaring (%) Rupture papillary muscles (%) Lipid profiles TC(mmol/l)-Mean(SD) HDL(mmol/l)-Mean(SD)
6.1 (0.9)
6.2 (0.21)
5.3 (0.4)
<0.0001)
6 (12.0%) 5 (10.0%) 10 (20.0%)
13 (26.0%) 13 (26.0%) 14 (28.0%)
7 (14%) 7 (14%) 7 (14%)
0.15 0.09 0.27
5.4 (0.3)
5.4 (0.3)
5.3 (0.5)
0.045
1.3 (0.1)
1.2 (0.1)
1.2 (0.1)
0.051
LDL(mmol/l)-Mean(SD)
3.4 (0.2)
3.3 (0.2)
3.7 (0.3)
<0.0001
TG(mmol/l)-Mean(SD) Need for readmission
1.5 (0.1) 0
1.5 (0.2) 0
1.6(0.20) 0
0.001 0
CV-mortality Heart failure Stroke
0 0 0
0 0 0
0 0 0
0 0 0
Table (12): Post MI Outcome at 12 months: Variables Group 1(n=50) Recurrent chest pain-% 0
Group 2(n=50) 0
Group 3(n=50) 0
p-value 0
FPG(mmol/l)-Mean(SD) 5.5 (0.5)
5.7 (0.6)
5.0 (0.6)
<0.0001)
HbA1c%-Mean(SD) Echo-complications Aneurysm (%) Scaring (%) Rupture papillary muscles (%) Lipid profiles TC(mmol/l)-Mean(SD) HDL(mmol/l)-Mean(SD)
6.1 (0.12)
6.1 (0.21)
5.3 (0.4)
<0.0001)
6 (12.0%) 5 (10.0%) 10 (20.0%0
13 (26.0%) 13 (26.0%) 14 (28.0%)
7 (14%) 7 (14%) 7 (14%)
0.15 0.09 0.27
5.4 (0.31)
5.4 (0.3)
5.3 (0.5)
0.03
M e T O 'c/4nMMneuaenc(SD) TG(mmol/l)-Mean( SD) Need for readmission CV-mortality Heart failure
1.2 (0.11)
1.2 (0.1)
1.3 (0.14)
0.007
3.3 (0.2) 1.4 (0.12)
3.3 (0.2) 1.5 (0.2)
3.7 (0.32) 1.64 (0.20)
<0.0001 <0.0001
0 0 0
0 0 0
0 0 0
0 0 0
Table (13): Univariate analysis and Univariate Relative Risk (RR) for poor outcome of AMI in diabetic patients treated with insulin infusion vs. sliding scale: Category
Insulin
Sliding
RR (95% CI)
P-value
infusion(n=50) Scale (n=50)
Recurrent chest pain 1
8
0.2 (0.03-1.32)
*0.036
Heart failure
5
10
0.63 (0.3-1.32)
0.26
Arrhythmia
6
9
0.77 (0.4-1.48)
0.57
Stroke
1
11
0.15 (0.02-0.99)
0.005
CV-mortality
3
9
0.47 (0.17-1.27)
0.12
Table (14): Univariate analysis and Univariate Relative Risk (RR) for poor outcome of AMI in diabetic patient's vs. non-diabetic patients: Category
Diabetic Non-diabetic (n=100) (n=50)
RR (95% CI)
P-value
Recurrent chest pain
9
9
0.73 (0.45-1.17)
0.18
Heart failure
15
9
0.93 (0.66-1.29)
0.8
Arrhythmia
15
7
1.03 (0.75-1.4)
0.93
Stroke
12
4
1.14 (0.84-1.55)
0.64
CV-mortality
12
4
1.14 (0.84-1.55)
0.64
Table (15): Multivariate Logistic Regression Analysis of poor outcome of AMI in diabetic patients treated with insulin infusion vs. sliding scale: Category
Insulin
infusion(n=50
Sliding scale (n=50)
RR (95% CI)
P-value
) Recurrent chest pain 1
8
0.124(0.14-1.177) 0.07
Heart failure
5
10
0.461(0.127-1.67) 0.24
Arrhythmia
6
9
0.952(0.225-4.03) 0.95
Stroke
1
11
0.092(0.0110.798)
0.03
CV-mortality
3
9
0.000
1.00
Table (16): Multivariate Logistic Regression Analysis of poor outcome of AMI in diabetic patients vs. non-diabetic patients: Category
Diabetic Non(n=100) diabetic (n=50)
RR (95% CI)
P-value
Recurrent chest pain
9
9
0.349(0.116-0.998) 0.05
Heart failure
15
9
1.255(0.438-3.594) 0.672
Arrhythmia
15
7
0.79(0.276-2.258)
0.66
Stroke
12
4
1.641(0.466-5.77)
0.441
CV-mortality
12
4
0.000
1.000
Table (17) Baseline biochemical characteristics of diabetic patients treated either with insulin infusion method or with sliding scale method Variables
Insulin infusion Group (n=50) (IIT)
Sliding Scale Group (n=50) (SSI)
Mean(SD)
95%CI of mean
Mean(SD)
Admission BG
17.2 (5.6)
15.6 to 18.8 17.3 (5.6)
15.7 to 18.8 0.94
HbA1c%
8.7 (1.7)
8.2 to 9.2
9.27 (1.5)
8.86 to 9.69 0.86
5.6 (1.1)
5.3 to 6
6.0 (1.0)
5.7 to 6.3
0.09
2.1 (1.0)
1.8 to 2.4
1.4 (0.52)
1.2 to 1.5
<0.000 1
LDL(mmol/l)
3.9 (1.3 )
3.6 to 4.3
4.3 (1.02)
4.01 to 4.7
o.120
TG(mmol/l)
2.0 (1.1)
1.7 to 2.3
3.3 (1.8)
2.8 to 3.8
<0.000 1
TC(mmol/l) HDL(mmol/l)
p-value
95%CI of mean
Table (18) Follow-up of biochemical characteristics of diabetic patients treated either with insulin infusion or with sliding scale at 3months: Variables
FPG(mmol /l) HbA1c% TC (mmol/l) HDL(mmol /l) LDL
Infusion group (n=50) (IIT) Mean (SD) 95% CI of
p-value
mean
Sliding scale group (n=50)(SSI) Mean (SD) 95% CI of mean
6 (0.6)
5.8 to 6.2
6.2 (0.74)
6 to 6.4
0.22
6.1 (0.23) 5.3 (0.5)
6 to 6.2 5.2 to 5.4
6.1 (0.2) 5.6 (0.35)
6 to 6.2 5.5 to 5.7
0.57 <0.0001
1.25 (0.2)
1.2 to 1.3
1.3 (0.2)
1.2 to 1.3
0.84
3.3 (0.26)
3.2 to 3.4
3.5 (0.33)
3.4 to 3.6
0.008
1.64 (0.21)
1.6 to 1.7
1.6 3(0.23)
1.56 to 1.7
0.9
(mmol/l) TG (mmol/l)
Table (19) Follow-up of biochemical characteristics of diabetic patients treated either with insulin infusion or with sliding scale at 6 months: Variables
Infusion group (n=50) (IIT) Mean (SD) 95% CI of
p-value
mean
Sliding scale group (n=50)(SSI) Mean (SD) 95% CI of mean
FPG(mmol/ 5.8 (0.5) l) HbA1c% 6.1 (0.13)
5.6 to 6.0
5.8 (0.43)
5.68 to 5.9
0.65
6.0 to 6.2
6.1 (0.1)
6 to 6.2
0.49
TC(mmol/l) 5.36 (0.29)
5.3 to 5.4
5.4 (0.27)
5.3 to 5.5
0.14
HDL(mmol 1.27 (0.13) /l) LDL(mmol 3.3 (0.17) /l) TG(mmol/l) 1.5 (0.14)
1.23 to 1.3
1.3 (0.1)
1.25 to 1.31
0.67
3.25 to 3.55 3.4 (0.23)
3.3 to 3.5
0.06
1.48 to 1.56 1.5 (0.2)
1.47 to 1.6
0.85
Table (20) Follow-up of biochemical characteristics of diabetic patients treated either with insulin infusion or with sliding scale at 12 months : Variables
Infusion group (n=50) Sliding scale group (IIT) (n=50)(SSI) Mean (SD) 95% CI of Mean (SD) 95% CI of
p-value
mean
mean
5.4 to 5.7 5.74 (0.48)
5.6 to 5.87
0.078
HbA1c(mmol/l) 6.13 (0.15) 6.1 to 6.2 6.13 (0.1)
6.1 to 6.16
0.94
TC(mmol/l)
5.38 (0.24) 5.3 to 5.45 5.4 (0.26)
5.36 to 5.5
0.24
HDL(mmol/l)
1.2 (0.12)
1.16 to 1.2
0.78
LDL(mmol/l)
3.3 (1.4)
3.29 to 3.39
0.23
TG(mmol/l)
1.4 (0.15)
1.35 to 1.45
0.8
FPG(mmol/l)
5.56 (0.5)
1.16 to 1.2 (0.96) 1.23 3.2 to 3.34 3.34 (o.17) 1.36 to 1.45
1.4 (0.16)
Table (21) One way analysis of variance (ANOVA) of the mean values of Glycemia and lipid profile between baseline, 3 months, 6 months and 12 months for insulin infusion group. Variables FPG (mmol/l)Mean(SD) HbA1c% Mean (SD)
TC(mmol/l) Mean (SD) HDL(mmol/l) Mean (SD) LDL(mmol/l) Mean (SD) TG(mmol/l) Mean (SD)
Baselines
3 months
6 months
12 months
ANOVA p-value
17.2 (5.6)
5.1 (0.6)
5.8 (0.5)
5.6 (0.51)
<0.0001
8.7 (1.7)
6.1 (0.23)
6.1 (0.12)
6.1 (0.15)
<0.0001
5.6 (1.1)
5.3 (0.5)
5.4 (0.3)
5.4 (0.24)
0.048
2.1 (0.1)
1.2 (0.2)
1.3 (0.13)
1.2 (0.12)
<0.0001
3.9 (1.3)
3.3 (0.3)
3.3 (0.2)
3.3 (0.14)
0.19
2.0 (1.1)
1.6 (0.2)
1.5 (0.14)
1.4 (0.15)
<0.0001
Table (22) One way analysis of variance (ANOVA) of the mean values of Glycemia and lipid profile between 3 months, 6 months and 12 months for insulin infusion group. Variables FPG(mmol/l) Mean(SD) HbA1c% Mean (SD) TC(mmol/l) Mean (SD) HDL(mmol/l) Mean (SD) LDL(mmol/l) Mean (SD) TG(mmol/l) Mean (SD)
3 months
6 months
12 months
ANOVA p-value
6.0 (0.6)
5.8 (0.5)
5.6 (0.51)
<0.0001
6.1 (0.2)
6.1 (0.12)
6.1 (0.2)
0.52
5.3 (0.5)
5.4 (0.3)
5.4 (0.24)
0.5
1.2 (0.2)
1.2 (0.1)
1.2 (0.1)
0.48
3.3 (0.3)
3.3 (0.2)
3.3 (0.14)
0.8
1.6 (0.21)
1.5 (0.14)
1.4 (0.15)
<0.0001
Table (23) One way analysis of variance (ANOVA) of the mean values of Glycemia and lipid profile between baseline, 3 months, 6 months and 12 months for sliding scale group. Variables FPG(mmol/l) Mean (SD) HbA1c% Mean (SD) TC(mmol/l) Mean (SD) HDL(mmol/l) Mean (SD) LDL(mmol/l) Mean (SD) TG(mmol/l) Mean (SD)
Baseline
3 months
6 months
12 months
ANOVA p-value
17.3 (5.6)
5.8 (0.42)
5.8 (0.43)
5.74( 0.48)
<0.0001
9.3 (1.5)
6.1 (0.2)
6.1 (0.1)
6.13 (0.01)
<0.0001
6.0 (1.02)
5.6 (0.35)
5.45 (0.27)
5.4 (0.26)
<0.0001
1.4 (0.52)
1.25 (0.18)
1.28 (0.01)
1.2 (0.1)
0.02
4.3 (1.02)
3.41(0.03)
3.36 (0.02)
3.32 (0.02)
<0.0001
3.3 (1.8)
1.63 (0.23)
1.53 (0.18)
1.4 (0.16)
<0.0001
Table (24) One way analysis of variance (ANOVA) of the mean values of Glycemia and lipid profile between 3 months, 6 months and 12 months for sliding scale group. Variables FPG(mmol/l) Mean(SD) HbA1c% Mean (SD) TC(mmol/l) Mean (SD) HDL(mmol/l) Mean (SD) LDL(mmol/l) Mean (SD) TG(mmol/l) Mean (SD)
3 months
6 months
12 months
ANOVA p-value
5.8 (0.42)
5.8 (0.43)
5.74( 0.48)
<0.0001
6.1 (0.2)
6.1 (0.1)
6.13 (0.1)
0.64
5.6 (0.35)
5.45 (0.27)
5.4 (0.26)
0.001
1.25 (0.18)
1.28 (0.01)
1.2 (0.1)
0.005
3.5 (0.33)
3.5 (0.23)
3.34 (0.17)
0.012
1.63 (0.23)
1.53 (0.18)
1.4 (0.16)
<0.0001
Figures
Figure (1): Distribution plot of the age group for male and female (normal distribution) in the study group (n=150).
Figure (2): Mean value of the age for male and female in the study group (150).
Figure (4); Killip classification in the study groups (n=150)
Figure (5): Different categories of social class calcification of the study group (n=150).
Figure(6): Mean value of the BMI (body mass index) for male and female in the study group (n150).
Figure (7): Mean value of waist circumference for male and female in the study group (150).
Figure (8): Mean value of the waist hip ratio for male and female in the study group (150).
Figure (9): Frequency of the resting segmental wall abnormality in the study group (n=150).
Figure (9-A): Frequency of resting segmental wall motion abnormality in the diabetic group (n=100)
Figure (12): Left system affection of the coronary artery for one of the diabetic group
Figure (13):left system coronary artery disease of one patient in the study.
Figure (14): left system affection of the coronary artery in the study
Figure (15): Multiple coronary artery disease of the one of the diabetic patient in the study.
Figure (16): Right coronary artery lesion of one of our patient in the study
Figure (17): Right coronary artery lesion of one of our patient in the study
Figure (18): Types of coronary artery lesions in the diabetic group (n=100).
Figure (19): Coronary system affection in the diabetic group (100).
Figure (21): Sex distribution for male and female in the diabetic group (n=100).
Figure (22); difference between the mean (95% CI) value of the admission blood glucose (ABG) for insulin infusion therapy (IIT) group and sliding scale insulin (SSI) group's p=0.94.
Figure (23); Difference between the mean (95%CI) value of the average blood glucose (ABG) for IIT and SSI group, p<0.0001.
Figure (24); Difference between the mean (95%CI) value of mean blood glucose (MBG) for IIT and SSI groups.
Figure (25a and 25b); Difference between the coefficient of variation (CV) of MBG for Insulin Infusion Therapy (IIT) group and Sliding Scale Insulin (SSI) group.
Conclusion: Insulin infusion therapy in diabetic patients with AMI seems to have better outcomes regarding arrhythmia, stroke and cardiovascular mortality compared to sliding scale insulin therapy.
Thank you