NICE Recommendations for Hyperglycaemia in ACS
NICE Recommendations for Hyperglycaemia in ACS
Two further reviews/clinical questions arose from the scope covering the subsequent management of ACS patients with hyperglycaemia without prior diagnosis of diabetes:
Five prognostic studies were identified that were relevant to the first question, whereas, no relevant studies could be identified for the second. The prognostic studies were of variable quality and relevance to UK practice, and evaluated different testing and diagnostic strategies for diabetes. Measurement of HbA1c and fasting blood glucose were the most reliable predictors of subsequent diabetes in these studies, with little additional role for oral glucose tolerance testing (although the evidence level was low or very low quality). Fasting blood glucose measured before day 4 may be unreliable, so this can be performed post-discharge in the community by the patient's primary care team. Approximately 25% of patients in the studies reviewed went on to be diagnosed with diabetes during limited follow-up of up to 3 months. However, the GDG felt that any patient with significant hyperglycaemia at the time of ACS was likely to be at increased risk for the development of diabetes for the rest of their life, and should, therefore, be formally tested at least annually. As there was no evidence in the literature to answer the second research question, the GDG felt that patients without known diabetes presenting with hyperglycaemia and ACS should be offered conventional lifestyle advice in line with existing NICE guidelines (see summary of recommendations Box 1 ).
From Evidence to Recommendations: Adults With Acute Coronary Syndromes and Hyperglycaemia Without a Previous Diagnosis of Diabetes
Two further reviews/clinical questions arose from the scope covering the subsequent management of ACS patients with hyperglycaemia without prior diagnosis of diabetes:
What are the risk factors associated with the development of diabetes in people with hyperglycaemia in ACS?
What information should patients with ACS and hyperglycaemia (who are at high risk for developing diabetes) be provided with before diagnostic investigations for diabetes?
Five prognostic studies were identified that were relevant to the first question, whereas, no relevant studies could be identified for the second. The prognostic studies were of variable quality and relevance to UK practice, and evaluated different testing and diagnostic strategies for diabetes. Measurement of HbA1c and fasting blood glucose were the most reliable predictors of subsequent diabetes in these studies, with little additional role for oral glucose tolerance testing (although the evidence level was low or very low quality). Fasting blood glucose measured before day 4 may be unreliable, so this can be performed post-discharge in the community by the patient's primary care team. Approximately 25% of patients in the studies reviewed went on to be diagnosed with diabetes during limited follow-up of up to 3 months. However, the GDG felt that any patient with significant hyperglycaemia at the time of ACS was likely to be at increased risk for the development of diabetes for the rest of their life, and should, therefore, be formally tested at least annually. As there was no evidence in the literature to answer the second research question, the GDG felt that patients without known diabetes presenting with hyperglycaemia and ACS should be offered conventional lifestyle advice in line with existing NICE guidelines (see summary of recommendations Box 1 ).
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