Role of Tight Glycemic Control during Acute Coronary Syndrome on CV Outcome in Type 2 Diabetes

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Term Occurence Count Dictionary
metabolic syndrome 2 endocrinologydiseases
pioglitazone 2 endocrinologydiseasesdrugs
diabetes mellitus 1 endocrinologydiseases
hyperglycemia 16 endocrinologydiseases
dapagliflozin 1 endocrinologydiseasesdrugs
hypoglycemia 10 endocrinologydiseases
metformin 3 endocrinologydiseasesdrugs
sitagliptin 1 endocrinologydiseasesdrugs
Insulin 4 endocrinologydiseasesdrugs
cortisol 1 endocrinologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
Insulin 9347 events or in the progression of coronary artery disease (CAD) in diabetic patients [[22]].4. Role of Insulin Resistance in ACSSignificant evidence supports the theory of a strict relationship between insulin resistance
Insulin 9693 attributable to an increased synthesis of nitric oxide and are deeply reduced in the insulin-resistant states. Insulin infusion, with algorithms aiming to provide an optimal blood glucose control, improves the clinical
Insulin 9864 glucose control, improves the clinical outcomes of patients with severe acute illness and ACS [[24]]. Insulin resistance causes a progressive endothelial dysfunction and modifications of glucose and lipid metabolism,
Insulin 15357 vascular resistance [[38]].As a confirmation of this hypothesis, the DIGAMI study (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) showed that GIKi administration in the early 24 hours
cortisol 24088 could be explained by specific neuroendocrine changes, such as increased circulating concentrations of cortisol , glucagon, and catecholamine. The extent of insulin resistance during surgery depends on the intensity
dapagliflozin 6001 the end of 2018, we expect the results of the DECLARE study, whose aim was to assess the CV effect of dapagliflozin on diabetic patients and also on the primary CV prevention (60% of enrolled population) [[13]].Actually,
metformin 7548 similar incidence of cardiovascular events with sulfonylureas and pioglitazone as add-on treatments to metformin .Because of these and many other evidences, we proposed to critically discuss the literature data regardless
metformin 17662 such as glycemic control, did not show any significant difference in mortality among sulphonylureas, metformin , and insulin. However, the risk of nonfatal myocardial infarction and stroke was significantly increased
metformin 17806 nonfatal myocardial infarction and stroke was significantly increased by insulin treatment, whilst metformin was protective.The most reasonable reason for the difference between DIGAMI 1 and 2 findings is that
pioglitazone 7317 the main secondary endpoint (all-cause mortality, myocardial infarction, and stroke) observed with pioglitazone in the secondary CV prevention [[17]]. Recently, the TOSCA.IT study [[18]], a long-term, pragmatic trial,
pioglitazone 7511 long-term, pragmatic trial, showed a similar incidence of cardiovascular events with sulfonylureas and pioglitazone as add-on treatments to metformin.Because of these and many other evidences, we proposed to critically
sitagliptin 6260 the other classes of antihyperglycemic agents.In fact, RCTs on DPP4i (saxagliptin, alogliptin, and sitagliptin ) showed a noninferiority for the primary endpoint of a composite of death from cardiovascular causes,
Select Disease Character Offset Disease Term Instance
diabetes mellitus 23755 better prognosis [[56]]. In reality, insulin resistance during surgery, rather than the presence of diabetes mellitus , is associated with an increased risk of major complications.It is well known that major surgical tissue
hyperglycemia 3110 higher in a female diabetic population [[2]]. Moreover, a linear positive relationship between admission hyperglycemia and mortality after ACS has been reported. However, in this setting of patients, the optimal management
hyperglycemia 8492 involved in the ACS development and progression among which are metabolic syndrome, insulin resistance, hyperglycemia , and oxidative stress [[20]]. Anyway, a clear understanding of the pathophysiologic mechanisms underlying
hyperglycemia 10126 cycle and eventually leading to an acute vascular damage [[23]]. Actually, both insulin resistance and hyperglycemia seem to play important roles in the pathogenesis of ACS.5. Effects of Hyperglycemia during ACSSeveral
hyperglycemia 10261 important roles in the pathogenesis of ACS.5. Effects of Hyperglycemia during ACSSeveral studies identified hyperglycemia as an independent risk factor for diabetic cardiomyopathy, through cardiac cell apoptosis [[25]]. Apoptotic
hyperglycemia 11114 protein kinase C (PKC), polyol pathway flux, and the hexosamine pathway. All of these reflect a single hyperglycemia -induced process of overproduction of superoxide by the mitochondrial electron transport chain [[20]].More
hyperglycemia 11347 fascinatingly, in a high-risk intensive cardiac care unit general population (only 17% had known diabetes), both hyperglycemia at admission (glucose ≥ 9 mmol/L) and sustained hyperglycemia during hospitalization (average
hyperglycemia 11417 17% had known diabetes), both hyperglycemia at admission (glucose ≥ 9 mmol/L) and sustained hyperglycemia during hospitalization (average glucose levels ≥ 8 mmol/L) were independent predictors of all-cause
hyperglycemia 19928 dramatic loss of MPC function in animal models. The high levels of oxygen reactive species, produced by hyperglycemia during AMI, result in the inhibition of both cell replication and differentiation, thus favoring the
hyperglycemia 20967 suggests that an increased inflammatory immune process seems to be most likely a mechanism linking acute hyperglycemia s to poor cardiac outcomes in AMI patients [[47]]. Inflammatory response and cytokine elaboration are
hyperglycemia 21917 peroxynitrite, hence producing a myocardial damage and a higher mortality after AMI [[51]].In addition to hyperglycemia , oxidative stress may be induced by soluble advanced glycation end products (AGE). Among AGE precursors,
hyperglycemia 22109 (AGE). Among AGE precursors, methylglyoxal (MG) is considered as one of the key intermediates linking hyperglycemia and intensive lipolysis, two dominant metabolic changes in diabetes [[52]]. Oxidized low-density lipoprotein
hyperglycemia 23942 well known that major surgical tissue trauma leads to alterations in glucose metabolism, resulting in hyperglycemia and insulin resistance. This could be explained by specific neuroendocrine changes, such as increased
hyperglycemia 25849 target of 81 to 108 mg/dL.9. Position Statements of Scientific SocietiesAll these studies confirm that hyperglycemia is common during ACS and is associated with increased mortality rates. Anyway, it remains still unclear,
hyperglycemia 26021 mortality rates. Anyway, it remains still unclear, as stated by the American Heart Association, whether hyperglycemia is either a marker or a mediator of higher mortality and whether hyperglycemia treatment improves outcomes
hyperglycemia 26100 Association, whether hyperglycemia is either a marker or a mediator of higher mortality and whether hyperglycemia treatment improves outcomes [[61]].Correctly, Scientific Societies, underlying the absence of robust
hyperglycemia 26613 according to DIGAMI 1, that DM and AMI would benefit from glycemic control, in the case of a significant hyperglycemia (higher than 10 mmol/L or 180 mg/dL), with the target adapted to possible comorbidities as a class
hypoglycemia 3984 increase the CV risk. Moreover, an intensive antihyperglycemic therapy increased the risk of severe hypoglycemia .On the other hand, the UKPDS [[6]] did not demonstrate a significant reduction of macrovascular events
hypoglycemia 4478 studies, younger, with less history of CV disease and neuropathy, lower baseline HbA1c, and lower risk of hypoglycemia .Actually, in a more recent metaregression analysis [[8]], a higher BMI, duration of diabetes and incidence
hypoglycemia 4608 more recent metaregression analysis [[8]], a higher BMI, duration of diabetes and incidence of severe hypoglycemia revealed to be associated with a greater risk of cardiovascular death in intensive treatment groups.
hypoglycemia 25096 therapy in critically ill patients determines an increased risk for serious adverse events related to hypoglycemia .Finally, the NICE-SUGAR study, a large, international, randomized trial [[60]], suggested that a goal
hypoglycemia 27402 considered in ACS patients with glucose levels > 10 mmol/L (>180 mg/dL), whilst episodes of hypoglycemia (defined as glucose levels ≤ 3.9 mmol/L or ≤70 mg/dL) should be avoided.Finally, the 2018
hypoglycemia 27991 doses. Remarkably, the treatment regimen should be reviewed and changed as necessary to prevent further hypoglycemia when a blood glucose value is ≤70 mg/dL (3.9 mmol/L) (level C of evidence).Notably, whilst all
hypoglycemia 28230 seem mandatory with regard to a strict hyperglycemic cutoff, instead, they agree to absolutely avoid hypoglycemia . Therefore, according to the recent joint position statement of the American Diabetes Association and
hypoglycemia 28408 the American Diabetes Association and the European Association for the Study of Diabetes [[65]], the hypoglycemia alert value in hospitalized patients has to be defined as blood glucose ≤ 70 mg/dL (3.9 mmol/L)
hypoglycemia 28554 patients has to be defined as blood glucose ≤ 70 mg/dL (3.9 mmol/L) and clinically significant hypoglycemia as glucose values < 54 mg/dL (3.0 mmol/L), to be reported in clinical trials. This statement
hypoglycemia 28964 studies on intensive glucose control must be developed to reduce both glucose variability and risk of hypoglycemia , thus achieving an optimal blood glucose concentration in critically ill patients, particularly in ACS
metabolic syndrome 8452 dysfunction [[19]].Many risk factors are involved in the ACS development and progression among which are metabolic syndrome , insulin resistance, hyperglycemia, and oxidative stress [[20]]. Anyway, a clear understanding of the
metabolic syndrome 8680 pathophysiologic mechanisms underlying the infarcted diabetic heart is still missing.In diabetic patients, metabolic syndrome is associated with a prothrombotic state, involving endothelial dysfunction, hypercoagulability, and

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