- NEWS . 09 Dec 2019
Establishing algorithms can help improve glucose and lipid management in patients with diabetes and ACS
Implementing decision-support algorithms was associated with improved inpatient glycaemic control and increased use of cardioprotective therapies at discharge in patients with diabetes mellitus (DM) and acute coronary syndrome (ACS).
DM is associated with increased risk of adverse outcomes after ACS, so researchers from Western Australia evaluated whether using algorithms to help translate the latest evidence-based recommendations into practice could help improve outcomes in a tertiary cardiac unit.
A multidisciplinary committee designed and implemented decision-support algorithms plus education, which were then applied in the unit to patients with diabetes admitted for ACS. A 3-month audit (phase 1) was conducted to evaluate hyperglycaemia and dyslipidaemia management, and medication prescriptions, as well as a 3-month post-implementation audit (phase 2).
There were 104 people in phase 1 and 101 in phase 2, with similar characteristics (glycated haemoglobin: 64±20 mmol/mol vs 61±21 mmol/mol [8.0±1.8% vs 7.8±1.9%]). Post implementation, the incidence of blood glucose levels >10 mmol/L was lower (phase 1, 46.4% vs phase 2, 31.8%; rate ratio [RR], 0.77; 95% confidence intervals [CI], 0.60–0.98; p=0.031), without a difference in blood glucose levels <5mmol/L (phase 1, 4.9% vs phase 2, 4.5%; RR, 1.20; 95% CI, 0.70–2.08; p=0.506). Sodium-glucose cotransporter-2 inhibitor prescriptions increased significantly (baseline to discharge: from 12.5% to 15.4% vs 7.9% to 24.8%; p=0.007) but high-intensity statin prescriptions did not (baseline to discharge: from 35.6% to 72.1% vs 40.6% to 85.1%; p=0.074). Prescription rates of non-statin lipid-lowering medications were not significantly increased.
Overall, implementing decision-support algorithms was associated with improved inpatient glycaemic control and increased use of cardioprotective therapies at discharge in patients with diabetes and ACS.
Lan NS, et al. Implementing simple algorithms to improve glucose and lipid management in people with diabetes and acute coronary syndrome. Diabet Med 2019;36:1643-1651.