diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/2072-0351-5938diaendo-5938Research ArticleСтатьиArticlesЗначение гликемического контроля в остром периоде инфаркта миокарда у больных сахарным диабетом 2 типаZnachenie glikemicheskogo kontrolya v ostrom periode infarkta miokarda u bol'nykh sakharnym diabetom 2 tipaСтронгинЛеонид ГригорьевичStronginLeonid Grigor'evichinfo@endojournals.ruБеляеваНатальяBelyaevaNatalya Геннадьевнаinfo@endojournals.ruПановаЕлена ИвановнаPanovaElena Ivanovnainfo@endojournals.ruНижегородская государственная медицинская академия, Нижний НовгородRussian Federation200815032008111№1 (2008)1518Copyright © Стронгин Л.Г., Беляева Н.Г., Панова Е.И., 20082008Стронгин Л.Г., Беляева Н., Панова Е.И.Strongin L.G., Belyaeva N.Г., Panova E.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/5938

Риск сердечно-сосудистых заболеваний (ССЗ) и смертности от них при сахарном диабете в 2?5 раза превышает популяционный. Среди больных острым инфарктом миокарда (ОИМ) доля больных сахарным диабетом (СД) по самым консервативным оценкам составляет 20?25%, а число пациентов с ненарушенным углеводным обменом менее половины. Эти данные European Heart Survey нашли полное подтверждение в аналогичном исследовании, проведенном в Китае, которое выявило лишь 35,8% пациентов с нормальным метаболизмом глюкозы. Гипергликемия является главным проявлением СД, значение которого как фактора риска ССЗ показано во многих исследованиях. Роль этого потенциально управляемого фактора при ОИМ естественно привлекает самое пристальное внимание.

сахарный диабет 2 типагликемический контрольинфаркт миокардаReferencesДедов И.И. Шестакова М. В.Сахарный диабет М.:«Универсум Паблишинг». 2003; - 282сДедов И.И. Шестакова М. В.Сахарный диабет М.:«Универсум Паблишинг». 2003; - 282сJohnstone M.T., Nesto R..Kahn R.C. et al. Joslin's Diabetes Mellitus, Lippincott Williams & Wilkins. 2004; Р. 976 - 977.Johnstone M.T., Nesto R..Kahn R.C. et al. Joslin's Diabetes Mellitus, Lippincott Williams & Wilkins. 2004; Р. 976 - 977.Clement S, Braithwate S et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004; 27:553 - 597.Clement S, Braithwate S et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004; 27:553 - 597.Bartnik M.et al. Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction. Eur. Heart J. 2004; 21: 1880 - 1890.Bartnik M.et al. Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction. Eur. Heart J. 2004; 21: 1880 - 1890.Da-Yi Hu, Chang-Yu Pan, Jin-Ming Yu for the China Heart Survey Groop. The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart Survey. Eur Heart J. 2006; 27: 2573 - 2579.Da-Yi Hu, Chang-Yu Pan, Jin-Ming Yu for the China Heart Survey Groop. The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart Survey. Eur Heart J. 2006; 27: 2573 - 2579.Bloomgarden, Z.: Cardiovascular Disease. Diabetes Care. 2006; 29: 1160 - 1166.Bloomgarden, Z.: Cardiovascular Disease. Diabetes Care. 2006; 29: 1160 - 1166.Bolk J, van der Ploeg T, Cornel JH, Arnold AE, Sepers J, Umans VA: Impaired glucose metabolism predicts mortality after a myocardial infarction. Int J Cardiol. 2001; 79: 207 - 214.Bolk J, van der Ploeg T, Cornel JH, Arnold AE, Sepers J, Umans VA: Impaired glucose metabolism predicts mortality after a myocardial infarction. Int J Cardiol. 2001; 79: 207 - 214.Sala J, Masia R, Gonzalez de Molina F-J, Fernandez-Real JM, Gil M, Bosh D, Ricart W, Senti M and Marrugat for the REGICOR Investigators: Short-term mortality of myocardial infarction patients with diabetes or Community Health. 2002; 56: 707 - 712.Sala J, Masia R, Gonzalez de Molina F-J, Fernandez-Real JM, Gil M, Bosh D, Ricart W, Senti M and Marrugat for the REGICOR Investigators: Short-term mortality of myocardial infarction patients with diabetes or Community Health. 2002; 56: 707 - 712.Foo K, Cooper J, Deaner A, Knight C, Suliman A, Ranjadayalan K, Timmis A.D.: A single srrum glucose measurements predicts adverse outcomes across the whole range of acute coronary syndromes. Heart (London) 2005; 5: 12 - 516.Foo K, Cooper J, Deaner A, Knight C, Suliman A, Ranjadayalan K, Timmis A.D.: A single srrum glucose measurements predicts adverse outcomes across the whole range of acute coronary syndromes. Heart (London) 2005; 5: 12 - 516.Wahab NN., Cowden EA, Pearce NJ et al., on behalf of the CONS Investigators. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol. 2002; 40: 1748 -1754.Wahab NN., Cowden EA, Pearce NJ et al., on behalf of the CONS Investigators. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol. 2002; 40: 1748 -1754.Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM: Admission glucose and mortality in elderly patient patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation. 2005; 111: 3078 - 3086.Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM: Admission glucose and mortality in elderly patient patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation. 2005; 111: 3078 - 3086.Goyal A, Mahaffey KW, Garg J, Nicolau JC, Hochman JS, Weaver WD, Theroux P, Oliveira GB, Todaro TG, Mojcik CF, Armstrong PW, Granger CB. (2006) Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the cardinal study. Eur Heart J. 27: 1289 - 1297.Goyal A, Mahaffey KW, Garg J, Nicolau JC, Hochman JS, Weaver WD, Theroux P, Oliveira GB, Todaro TG, Mojcik CF, Armstrong PW, Granger CB. (2006) Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the cardinal study. Eur Heart J. 27: 1289 - 1297.Lenzen M, Ryden L, Ohrvik J, Bartnik M, Malmberg K, Scholte op Reimer W, Simoons Ml: Diabetes known or newly detected, but not impaired glucose regulation, has a negative influence on 1-year outcome in patient with coronary artery disease: a report from the Euro Heart Survey on diabetes and heart. Eur Heart J. 2006; 27: 2969 - 2974.Lenzen M, Ryden L, Ohrvik J, Bartnik M, Malmberg K, Scholte op Reimer W, Simoons Ml: Diabetes known or newly detected, but not impaired glucose regulation, has a negative influence on 1-year outcome in patient with coronary artery disease: a report from the Euro Heart Survey on diabetes and heart. Eur Heart J. 2006; 27: 2969 - 2974.Aguilar D, Solomon S.D, Kober L, Roulean J-L, Skali H, McMurray J.J.V, Fransis G.S, Henis M, O'Connor C.M, Dias R, Belenkov Y.N, Varshavsky S, Leimberger J.D, Velazquez E.J, Califf R, Pfeffe M.A: Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction - the VALsartan In Acute myocardial infarction. Circulation. 2004; 21: 1572 - 1578.Aguilar D, Solomon S.D, Kober L, Roulean J-L, Skali H, McMurray J.J.V, Fransis G.S, Henis M, O'Connor C.M, Dias R, Belenkov Y.N, Varshavsky S, Leimberger J.D, Velazquez E.J, Califf R, Pfeffe M.A: Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction - the VALsartan In Acute myocardial infarction. Circulation. 2004; 21: 1572 - 1578.Kersten J, Schmeling T, Orth K, Pagel P, Warltier D: Acute hyperglycemia abolishes ischemic preconditioning in vivo. Am J Physiol. 1998; 275:721 - 725.Kersten J, Schmeling T, Orth K, Pagel P, Warltier D: Acute hyperglycemia abolishes ischemic preconditioning in vivo. Am J Physiol. 1998; 275:721 - 725.Kersten J, Toller W, Tessmer J, Pagel P, Warltier D: Hyperglycemia reduces coronary collarteral blood flow through a nitric oxide-mediated mechanism. Am J Physiol. 2001; 281: 2097 - 2104.Kersten J, Toller W, Tessmer J, Pagel P, Warltier D: Hyperglycemia reduces coronary collarteral blood flow through a nitric oxide-mediated mechanism. Am J Physiol. 2001; 281: 2097 - 2104.Ceriello A, Quagliaro L, D'Amico M, Di Filippo C, Marfella R, Nappo F, Berrino L, Rossi F, Giugliano D: Acute hyperglycemia induces nitrotyrosine formation and apoptosis in perfused heart from rat. Diabetes 2002; 51:1076 - 1082.Ceriello A, Quagliaro L, D'Amico M, Di Filippo C, Marfella R, Nappo F, Berrino L, Rossi F, Giugliano D: Acute hyperglycemia induces nitrotyrosine formation and apoptosis in perfused heart from rat. Diabetes 2002; 51:1076 - 1082.Verma S, Maitland A, Weisel R, Li S, Fedak P, Pomroy N, Mickle D, Li R, Ko L, Rao V: Hyperglycemia exaggerates ischemia-reperfusion-induced cardiomyocyte injury: reversal with endothelin antagonism. /J Thorac Cardiovasc Surg. 2002; 123:1120-1124.Verma S, Maitland A, Weisel R, Li S, Fedak P, Pomroy N, Mickle D, Li R, Ko L, Rao V: Hyperglycemia exaggerates ischemia-reperfusion-induced cardiomyocyte injury: reversal with endothelin antagonism. /J Thorac Cardiovasc Surg. 2002; 123:1120-1124.Marfella R, Nappo F, Angelis LD, Paolisso G, Tagliamonte M, Giugliano D: Hemodynamic effects of acute hyperglycemia in type 2 diabetic patients. Diabetes Care. 2000; 23: 658 - 663.Marfella R, Nappo F, Angelis LD, Paolisso G, Tagliamonte M, Giugliano D: Hemodynamic effects of acute hyperglycemia in type 2 diabetic patients. Diabetes Care. 2000; 23: 658 - 663.Marfella R, Nappo F, Angelis LD, Siniscalshi M, Rossi F, Giugliano D: The effect of acute hyperglycaemia on QTc duration in healthy man. Diabetologia. 2000; 43:571 - 57.Marfella R, Nappo F, Angelis LD, Siniscalshi M, Rossi F, Giugliano D: The effect of acute hyperglycaemia on QTc duration in healthy man. Diabetologia. 2000; 43:571 - 57.Cinar Y, Senyol A, Duman K: Blood viscosity and blood pressure: role of temperature and hyperglycemia. American J Hypertens. 2001; 14: 433-438.Cinar Y, Senyol A, Duman K: Blood viscosity and blood pressure: role of temperature and hyperglycemia. American J Hypertens. 2001; 14: 433-438.McKenna K, Smith D, Tormey W, Thompson C: Acute hyperglycaemia causes elevation in plasma atrial natriuretic peptide concentrations in type 1 diabetes mellitus. Diabet Med. 2000;17: 512-517.McKenna K, Smith D, Tormey W, Thompson C: Acute hyperglycaemia causes elevation in plasma atrial natriuretic peptide concentrations in type 1 diabetes mellitus. Diabet Med. 2000;17: 512-517.Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenstrom A, Wedel H, Welin L: Randomised trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI Study): effects on mortality at 1 year. J Am Coll Cardiol. 1995; 26: 57 - 65.Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenstrom A, Wedel H, Welin L: Randomised trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI Study): effects on mortality at 1 year. J Am Coll Cardiol. 1995; 26: 57 - 65.Malmberg K, Ryden L et al: Effects of insulin treatment on cause- specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. European Heart J. 1996; 9:1337 - 1344.Malmberg K, Ryden L et al: Effects of insulin treatment on cause- specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. European Heart J. 1996; 9:1337 - 1344.Malmberg K: Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. BMJ. 1997; 314: 1512 - 1520.Malmberg K: Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. BMJ. 1997; 314: 1512 - 1520.Malmberg K, Ryden L, Wedel H, Birkeland K, Bootsma A, Dickstein K, Efendic S, Fisher M, Hamsten A, Herlitz J, Hildebrandt P, Macleod K, Laakso M, Torp-Pedersen C, Waldenstrom A: Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005; 26:650 - 661.Malmberg K, Ryden L, Wedel H, Birkeland K, Bootsma A, Dickstein K, Efendic S, Fisher M, Hamsten A, Herlitz J, Hildebrandt P, Macleod K, Laakso M, Torp-Pedersen C, Waldenstrom A: Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005; 26:650 - 661.Melikian N, Farzin Fath-Ordoubadi: The role of glucose-insulin-potassium therapy in the current management of acute myocardial infarction. The British Journal of Cardiology. 2003; 1:10.Melikian N, Farzin Fath-Ordoubadi: The role of glucose-insulin-potassium therapy in the current management of acute myocardial infarction. The British Journal of Cardiology. 2003; 1:10.Van der Horst ICC, Zijlstra F, van't Hof AWJ, Doggen CJM, de Boer MJ, Suryapranata H, Hoorntje JCA, Dambrink JHE, Gans ROB, Bilo HJG: Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 2003; 42:784 - 791.Van der Horst ICC, Zijlstra F, van't Hof AWJ, Doggen CJM, de Boer MJ, Suryapranata H, Hoorntje JCA, Dambrink JHE, Gans ROB, Bilo HJG: Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 2003; 42:784 - 791.Apstein CS. The benefits of glucose-insulin-potassium for acute myocardial infarction (and some concerns). J Am Coll Cardiol. 2003; 42:792-795.Apstein CS. The benefits of glucose-insulin-potassium for acute myocardial infarction (and some concerns). J Am Coll Cardiol. 2003; 42:792-795.Hirsch I., Goldfarb B. Study confirms need for metabolic control in diabetes after heart attack. DIGAMI 2 fails to replicate key result of DIGAMI 1, but study design may by a factor. DOCNews 2004 Oct 1, Vol 1, 2: 1 http://docnews.diabetesjournals.orgHirsch I., Goldfarb B. Study confirms need for metabolic control in diabetes after heart attack. DIGAMI 2 fails to replicate key result of DIGAMI 1, but study design may by a factor. DOCNews 2004 Oct 1, Vol 1, 2: 1 http://docnews.diabetesjournals.orgN. Wah Cheung, PHD, Vincent W. Wong, PHD and Mark McLean, PHD The Hyperglycemia: Intensive Insulin Infusion In Infarction (HI-5) Study A randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care. 2006; 29: 765 - 770.N. Wah Cheung, PHD, Vincent W. Wong, PHD and Mark McLean, PHD The Hyperglycemia: Intensive Insulin Infusion In Infarction (HI-5) Study A randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care. 2006; 29: 765 - 770.Hirsch I. Were we wrong about insulin and acute myocardial infarction? /DOCNews 2004, Vol 1, 2: 4. http://docnews.diabetesjournals.org/cgi/content/full/1/2/4Hirsch I. Were we wrong about insulin and acute myocardial infarction? /DOCNews 2004, Vol 1, 2: 4. http://docnews.diabetesjournals.org/cgi/content/full/1/2/4Irl B. Hirsch, Richard M. Bergenstal, Christopher G. Parkin, Eugene Wright, Jr., and John B. Buse, A Real-World Approach to Insulin Therapy in Primary Care Practice. Clinical Diabetes. 2005; 23:78 - 86.Irl B. Hirsch, Richard M. Bergenstal, Christopher G. Parkin, Eugene Wright, Jr., and John B. Buse, A Real-World Approach to Insulin Therapy in Primary Care Practice. Clinical Diabetes. 2005; 23:78 - 86.M. Kosuge , Kazuo Kimura, Toshiyuki Ishikawa, Tomoaki Shimizi, Kiyoshi Hibi, Noritaka Toda, Yoshio Tahara, Masakio Kanna, Kengo Tsukahara, Jyunn Okuda, Naoki Nozawa, Satoshi Umemura Persistent hyperglycemiais associated with left ventricular dysfunction in patients with acute myocardial infarction. Circulation Journal. 2005; Vol. 69, N 123 - P.23-28.M. Kosuge , Kazuo Kimura, Toshiyuki Ishikawa, Tomoaki Shimizi, Kiyoshi Hibi, Noritaka Toda, Yoshio Tahara, Masakio Kanna, Kengo Tsukahara, Jyunn Okuda, Naoki Nozawa, Satoshi Umemura Persistent hyperglycemiais associated with left ventricular dysfunction in patients with acute myocardial infarction. Circulation Journal. 2005; Vol. 69, N 123 - P.23-28.Zarich S, Nesto R. Implications and Treatment of Acute Hyperglycemia in the Setting of Acute Myocardial Infarction. Circulation. 2007; 115: P436 - 439.Zarich S, Nesto R. Implications and Treatment of Acute Hyperglycemia in the Setting of Acute Myocardial Infarction. Circulation. 2007; 115: P436 - 439.Strongin L.G., Beliaeva N.G. Aggressive glycemic control preserves cardiac function in patients with acute myocardial infarction and diabetes mellitus. Diabetologia. 2007; 50. Suppl. 1: 47.Strongin L.G., Beliaeva N.G. Aggressive glycemic control preserves cardiac function in patients with acute myocardial infarction and diabetes mellitus. Diabetologia. 2007; 50. Suppl. 1: 47.Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur. Heart J. 2007; 28(1): 88 - 136.Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur. Heart J. 2007; 28(1): 88 - 136.Beliaeva N.G., Strongin L.G., Shevcova N.U., Panova E.I. Effect of improved diabetic control in patient with acute myocardial infarction and diabetes mellitus. European Journal of Clinical investigation. 2007; 37. - Suppl. 1:70.Beliaeva N.G., Strongin L.G., Shevcova N.U., Panova E.I. Effect of improved diabetic control in patient with acute myocardial infarction and diabetes mellitus. European Journal of Clinical investigation. 2007; 37. - Suppl. 1:70.Svensson A, Darren K, Dellborg M: association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J. 2005; 26: 1255 - 1261.Svensson A, Darren K, Dellborg M: association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J. 2005; 26: 1255 - 1261.Goldberg et al: Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes care 2004; 27: 46.Goldberg et al: Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes care 2004; 27: 46.Vogelzang M. and Zijlstra F. Glucose metabolism and acute myocardial infarction. Eur. Heart J. 2006; 27(11): 1264 - 1265.Vogelzang M. and Zijlstra F. Glucose metabolism and acute myocardial infarction. Eur. Heart J. 2006; 27(11): 1264 - 1265.Grainger A., Eiden K., Kemper J., and D. Reeds. A Pilot Study to Evaluate the Effectiveness of Glargine and Multiple Injections of Lispro in Patients With Type 2 Diabetes Receiving Tube Feedings in a Cardiovascular Intensive Care Unit Nutr Clin Pract. 2007; 22 (5): 545 - 552.Grainger A., Eiden K., Kemper J., and D. Reeds. A Pilot Study to Evaluate the Effectiveness of Glargine and Multiple Injections of Lispro in Patients With Type 2 Diabetes Receiving Tube Feedings in a Cardiovascular Intensive Care Unit Nutr Clin Pract. 2007; 22 (5): 545 - 552.

The authors declare that there are no conflicts of interest present.