Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Abstract

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions AbstractPurpose: The purpose of this study was to evaluate the feasibility and safety of continuous glucose monitoring systems (CGMS) in ST segment elevation myocardial infarction (S-TEMI) patients undergoing primary percutaneous coronary interventions (p-PCI) in coronary care units (CCU).Methods: CGMS was performed for 3 days during CCU hospitalization for each of the subjects. The correlation between glucose values, recorded with CGMS, and finger-stick capillary glucose values was examined. The parameters and safety of CGMS were also investigated.Results: Data from 219 subjects were included in the statistical analysis. Correlation analysis showed a strong positive correlation between interstitial glucose values recorded by CGMS and the corresponding capillary glucose values (P<0.001). The daytime mean blood glucose MBG), the nighttime MBG and PT7.8 were the highest in the first day of CGMS compared with the second and third day. Furthermore, there were no indications of major hemorrhage or hematoma at the site of sensor insertion. Any adverse events were mild.Conclusions: CGMS glucose values are relatively accurate and reliable. CGMS were safe and can be used as a tool to detect trends in glucose levels and to predict upcoming glucose excursions in STEMI patients undergoing p-PCI. It is commonly accepted that continuous glucose monitoring systems (CGMS) can provide detailed and accurate glucose information. Relaying this detailed glucose information to patients has been shown to have a positive influence on glycemic control, including reductions in glucose variability, time spent in nocturnal hypoglycemia, time spent in hyperglycemia and levels of glycosylated hemoglobin [1][2][3][4]. Hyperglycemia commonly occurs during acute myocardial infarction (AMI), and in-hospital hyperglycemia is a strong predictor of mortality in AMI patients both with and without a history of diabetes mellitus [5][6]. The adverse outcomes associated with in-hospital hyperglycemia have prompted professional societies to recommend glucose control in AMI patients [5][6][7]; however, implementation of glucose control has been hindered by fear of hypoglycemia, as low glucose levels have been associated with adverse outcomes in AMI patients [8][9]. Patients with STsegment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary interventions (p-PCI) should receive aggressive management and treatment in coronary care units (CCU). As glucose management is a significant component of CCU activity, CGMS are particularly attractive for managing blood glucose (BG) because of their potential to detect hypo-and hyperglycemia as they occur. Many studies have concluded that CGMS face challenges in terms of sensitivity, stability, calibration and the physiological delay between BG and interstitial glucose (IG) concentration [10][11][12]. Moreover, CGMS are more e...