Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial Centre for Translational and Experimental Medicine, Imperial College London, Du Cane Road, London, W12 0NN, London, United Kingdom.
Faculty of Medicine, Department of Metabolism, Digestion and Reproduction Imperial College London, London, United Kingdom.
Diabetes Res Clin Pract. 2023 May;199:110644. doi: 10.1016/j.diabres.2023.110644. Epub 2023 Mar 29.
Diabetes is a highly prevalent disease associated with considerable cardiovascular end organ damage and mortality. Despite significant changes to the management of acute myocardial infarction over the last two decades, people with diabetes remain at risk of complications and mortality following a myocardial infarct for a multitude of reasons, including increased coronary atherosclerosis, associated coronary microvascular dysfunction, and diabetic cardiomyopathy. Dysglycaemia causes significant endothelial dysfunction and upregulation of inflammation within the vasculature and epigenetic changes mean that these deleterious effects may persist despite subsequent efforts to tighten glycaemic control. Whilst clinical guidelines advocate for the avoidance of both hyper- and hypoglcyaemia in the peri-infarct period, the evidence base is lacking, and currently there is no consensus on the benefits of glycaemic control beyond this period. Glycaemic variability contributes to the glycaemic milieu and may have prognostic importance following myocardial infarct. The use of continuous glucose monitoring means that glucose trends and parameters can now be captured and interrogated, and its use, along with newer medicines, may provide novel opportunities for intervention after myocardial infarction in people with diabetes.
糖尿病是一种高发疾病，可导致严重的心血管终末器官损伤和死亡率。尽管在过去二十年中，急性心肌梗死的治疗发生了重大变化，但由于多种原因，包括冠状动脉粥样硬化加重、相关冠状动脉微血管功能障碍和糖尿病心肌病，糖尿病患者在心肌梗死后仍有发生并发症和死亡的风险。高血糖会导致血管内皮功能显著障碍和炎症上调，表观遗传变化意味着，尽管随后努力加强血糖控制，这些有害影响仍可能持续存在。虽然临床指南主张在梗死期避免高血糖和低血糖，但目前缺乏证据，并且对于超过这一时期的血糖控制的益处目前还没有共识。血糖变异性会影响血糖环境，并且在心肌梗死后可能具有预后意义。连续血糖监测的使用意味着现在可以捕获和检测血糖趋势和参数，它的使用以及新的药物可能为糖尿病患者心肌梗死后的干预提供新的机会。
