Outcomes of acute myocardial infarction in type 2 diabetic yemeni patients using different methods of treament

Abstract

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 fourfold increase incidence of disease related to atheroma. 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. We recruited all patients admitted to the intensive care units (cardiac and noncardiac)at Al-Thawra Teaching Hospital in Sana’a over 12 months (Jan 2007–Dec 2010). 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. 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. Recurrent chest pain found to be more frequent among diabetics treated with IIT (38%) than those treated with SSI (18%), p = 0.04. 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. 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.