Effect Of Blood Glucose Management On Complications Of Acute Myocardial Infarction-A Meta-analysis

Objectives To evaluate the target value of blood glucose management and the incidence of complications in patients with myocardial infarction.Methods The authors searched Pub Med,EMBASE,Cochrane Library,CBM,CNKI,Wangfang Database,and VIP database for the randomized controlled trial(RCT)about the management of blood glucose by using insulin and the corresponding complications in patients with myocardial infarction from inception to December 2018。Screening and data extraction of relevant literature,literature quality evaluation according to the improved Jadad score and meta-analysis of RCTs meeting quality standards。 The primary outcome of the assessment was the patient’s all-cause mortality,and secondary outcomes are hypoglycemia,heart failure and arrhythmia.The methodological quality of the study was assessed.Assuming inter-study heterogeneity,a random effects model(Mantel-Haenszel)was used to compare event rates using a relative risk forest map(RR;95% confidence interval [CI]).Statistical analysis was performed using Review Manager V5.3 Because of the different definitions of blood glucose control levels in each study,this study was roughly stratified according to the blood glucose target,strict glycemic control group(blood sugar level 4.0-7.0 mmol/L);loose blood glucose control group(7.0-10.0 mmol/L),and free blood sugar control group(>11.0 mmol/L or routine metabolic management according to local practice).Results A total of 14 RCTs were included.Total N = 3502),with loose glycemic control and free glycemic control,no difference in mortality between the two groups(RR = 0.82,95% CI: 0.52-1.27,P = 0.37),hypoglycemia(RR = 7.46,95)% CI: 0.91-61.06,P=0.06)and the incidence of heart failure(RR=0.63,95% CI: 0.35-1.13,P=0.12)were also not statistically different.The strict glycemic control group and the loose blood glucose control group showed a strict blood glucose control group mortality(RR=0.53,95% CI:0.38-0.74,P<0.001),arrhythmia incidence rate(RR=0.58,95% CI:0.47-0.71,P < 0.00001)were lower than loose blood glucose control,but the incidence of hypoglycemia also increased(RR=3.29,95% CI:2.01-5.37,P<0.0001),and the incidence of heart failure was not statistically significant.(RR=0.66,95% CI: 0.41-1.06,P=0.09)Conclusions In summary,for acute myocardial infarction patients with elevated blood glucose,it is recommended to strictly control blood glucose,and adjust blood glucose control targets according to changes in the condition to avoid hypoglycemic events.