Checking on Blood Glucose

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Assessment of physician response to glycemic control in diabetic patients presenting with an acute coronary syndrome, by D.L.G. Conaway and colleagues. Am Heart Jrnl 152:1022–1027, 2006.

What is the problem and what is known about it so far?

People with diabetes are more likely to suffer acute coronary syndrome (ACS, disease of the heart’s blood vessels) or heart attack, and more likely to have a poor outcome. Research suggests that aggressively treating high blood glucose can help one recover from acute illness, but it isn’t known how often doctors check blood glucose levels on patients admitted for ACS.

Why did the researchers do this particular study?

The researchers wanted to see how often doctors check blood glucose levels on hospitalized patients being treated for ACS and, if they did, whether doctors acted on that information.

Who was studied?

The study included 968 people with ACS treated at one medical center.

How was the study done?

Participants had a physical exam, including tests to assess the health of the heart and its blood vessels, and blood tests to measure glucose levels. Researchers looked at what drugs were taken by the patient when admitted to the hospital and discharged; they wanted to see whether treatment included attention to high blood glucose levels.

What did the researchers find?

Among all the people with ACS, 24% had diabetes. Levels of A1C (a measure of long-term glucose control) were checked in 69% of all patients, and when it was checked, A1C was found high 60% of the time.

Only 42% of those with high A1C levels had their diabetes therapy regimen increased.

What were the limitations of the study?

All study participants were treated at one medical center. Practices may be different at other medical centers. It isn’t known how many participants had A1C levels checked before being admitted for ACS, or whether any of them were treated for high glucose levels by their primary care doctor after being discharged from the hospital.

What are the implications of the study?

Doctors don’t check blood glucose levels often enough on patients admitted for ACS, and when they do steps aren’t taken often enough to treat high blood glucose. Treating high blood glucose more aggressively may help more people survive and recover well from ACS.