--- title: "Glucose normalization and outcomes in patients with AMI. | Sutter Health" description: "Glucose normalization after admission is associated with better survival in hyperglycemic patients hospitalized with acute myocardial infarction whether or not they receive insulin therapy." url: "https://www.sutterhealth.org/research/publications/glucose-outcomes-in-ami-pts-1055312974" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Glucose normalization and outcomes in patients with AMI. # Glucose normalization and outcomes in patients with acute myocardial infarction. Kosiborod M, Inzucchi SE, Krumholz HM, Masoudi FA, Goyal A, Xiao L, Jones PG, Fiske S, & Spertus JA. _Arch Intern Med. 169(5):438-46. doi: 10.1001/archinternmed.2008.593._ 2009-03-09 ## Abstract BACKGROUND: Elevated blood glucose levels on admission are associated with increased mortality in patients with acute myocardial infarction. Whether glucose normalization after admission is associated with improved survival remains controversial. In addition, whether outcomes differ in patients who have spontaneous resolution of hyperglycemia vs those who achieve normoglycemia after treatment with insulin is also unknown. METHODS: We studied 7820 hyperglycemic (admission glucose level, > or =140 mg/dL \[to convert glucose to millimoles per liter, multiply by 0.0555\]) patients with acute myocardial infarction hospitalized between January 1, 2000, and December 31, 2005, in 40 US hospitals. Patients were stratified according to their mean glucose levels after admission and were divided into those who did and did not receive insulin therapy. Multivariable logistic regression models were developed to examine whether lower glucose levels after admission are independently associated with better survival. Propensity-matching methods were then used to compare in-hospital mortality in patients who did and did not receive insulin therapy. RESULTS: After multivariable adjustment, lower mean postadmission glucose levels were associated with better survival (for mean postadmission glucose levels of 110 to <140, 140 to <170, 170 to <200, and > or =200 mg/dL, the odds ratios \[95% confidence intervals\] were 2.1 \[1.3-3.5\], 5.3 \[3.0-8.6\], 6.9 \[4.1-11.4\], and 13.0 \[8.0-21.3\], respectively, vs <110 mg/dL). Similar results were seen in patients who did and did not receive insulin therapy (P =.74 for insulin therapy x postadmission glucose level interaction). In propensity-matched analysis, mortality rates were similar between insulin-treated and non-insulin-treated patients across the spectrum of mean postadmission glucose levels (range, P = .15 to P = .91). CONCLUSIONS: Glucose normalization after admission is associated with better survival in hyperglycemic patients hospitalized with acute myocardial infarction whether or not they receive insulin therapy. A strategy of intentional glucose lowering with insulin therapy needs to be further tested in future randomized controlled trials. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/19273773) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Endocrinology and Metabolism](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Endocrinology+and+Metabolism%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk.](https://www.sutterhealth.org/research/publications/glucometrics-pts-hospitalized-ami-1055312977) Kosiborod M, Inzucchi SE, Krumholz HM, Xiao L, Jones PG, Fiske S, Masoudi FA, Marso SP, Spertus JA. Circulation. 117(8):1018-27. doi: 10.1161/CIRCULATIONAHA.107.740498. Epub 2008 Feb 11. 2008 Feb 26 - Publication ### [Nonrigid autofocus motion correction for coronary MR angiography with a 3D cones trajectory.](https://www.sutterhealth.org/research/publications/nonrigid-autofocus-motion-correctn-ht-mra-1055312469) Ingle RR, Wu HH, Addy NO, Cheng JY, Yang PC, Hu BS, Nishimura DG. Magn Reson Med. 72(2):347-61. doi: 10.1002/mrm.24924. Epub 2013 Sep 4. 2014 Aug 01 - Publication ### [Cardiovascular magnetic resonance phase contrast imaging.](https://www.sutterhealth.org/research/publications/cardiovasc-mri-phase-contrast-1055312458) Nayak KS, Nielsen JF, Bernstein MA, Markl M, D Gatehouse P, M Botnar R, Saloner D, Lorenz C, Wen H, S Hu B, Epstein FH, N Oshinski J, Raman SV. J Cardiovasc Magn Reson. 17(1):71. doi: 10.1186/s12968-015-0172-7. 2015 Aug 09 - Publication ### [Combined outer volume suppression and T2 preparation sequence for coronary angiography.](https://www.sutterhealth.org/research/publications/outer-vol-suppressn-t2-prepseq-ht-angiography-1055312448) Luo J, Addy NO, Ingle RR, Hargreaves BA, Hu BS, Nishimura DG, Shin T. Magn Reson Med. 74(6):1632-9. doi: 10.1002/mrm.25575. Epub 2014 Dec 17. 2015 Dec 01 - Publication ### [Rapid single-breath-hold 3D late gadolinium enhancement cardiac MRI using a stack-of-spirals acquisition.](https://www.sutterhealth.org/research/publications/rapid-3d-gadolinium-enhancemt-cardiac-mri-1055312461) Shin T, Lustig M, Nishimura DG, Hu BS. J Magn Reson Imaging. 40(6):1496-502. doi: 10.1002/jmri.24494. Epub 2013 Nov 15. J Magn Reson Imaging. 40(6):1496-502. doi: 10.1002/jmri.24494. Epub 2013 Nov 15. Send to: 2014 Dec 02 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/glucose-outcomes-in-ami-pts-1055312974#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Glucose normalization and outcomes in patients with AMI."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/glucose-outcomes-in-ami-pts-1055312974#medicalscholarlyarticle","name":"Glucose normalization and outcomes in patients with acute myocardial infarction.","headline":"Glucose normalization and outcomes in patients with AMI.","abstract":"BACKGROUND: Elevated blood glucose levels on admission are associated with increased mortality in patients with acute myocardial infarction. Whether glucose normalization after admission is associated with improved survival remains controversial. In addition, whether outcomes differ in patients who have spontaneous resolution of hyperglycemia vs those who achieve normoglycemia after treatment with insulin is also unknown. METHODS: We studied 7820 hyperglycemic (admission glucose level, > or =140 mg/dL [to convert glucose to millimoles per liter, multiply by 0.0555]) patients with acute myocardial infarction hospitalized between January 1, 2000, and December 31, 2005, in 40 US hospitals. Patients were stratified according to their mean glucose levels after admission and were divided into those who did and did not receive insulin therapy. Multivariable logistic regression models were developed to examine whether lower glucose levels after admission are independently associated with better survival. Propensity-matching methods were then used to compare in-hospital mortality in patients who did and did not receive insulin therapy. RESULTS: After multivariable adjustment, lower mean postadmission glucose levels were associated with better survival (for mean postadmission glucose levels of 110 to \u003c140, 140 to \u003c170, 170 to \u003c200, and > or =200 mg/dL, the odds ratios [95% confidence intervals] were 2.1 [1.3-3.5], 5.3 [3.0-8.6], 6.9 [4.1-11.4], and 13.0 [8.0-21.3], respectively, vs \u003c110 mg/dL). Similar results were seen in patients who did and did not receive insulin therapy (P =.74 for insulin therapy x postadmission glucose level interaction). In propensity-matched analysis, mortality rates were similar between insulin-treated and non-insulin-treated patients across the spectrum of mean postadmission glucose levels (range, P = .15 to P = .91). CONCLUSIONS: Glucose normalization after admission is associated with better survival in hyperglycemic patients hospitalized with acute myocardial infarction whether or not they receive insulin therapy. 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