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‫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

SHA24/057001  

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