Evidence-Based Recommendations in Hyperglycemia and Acute Coronary Syndromes

Presented By:		CME e-Newsletter, 2009 Regional Practice Report

Program Description:	This CME activity consists of an educational component (ie, slides, audio lecture, newsletter) in an electronic format, followed by an online post-test. Estimated time to complete this activity, including review of materials, is 1 hour.
General Information:	Requirements for Successful Completion: This CME activity consists of a newsletter and online post-test. There is no fee to participate in this CME activity or to receive CME credit. Certificates are awarded upon successful completion (80% proficiency) of the post-test. In order to receive credit, participants must read the newsletter in its entirety. Media: Internet Release Date:    November 11, 2009 Expiration Date:  November 10, 2011
Target Audience:	Clinical cardiologists, emergency medicine physicians, endocrinologists, internal medicine physicians, medical directors, nurse practitioners, physician assistants, critical care nurses, and intensive care nurses.
Program Overview:	In the hospital setting, optimal blood glucose continues to be an elusive goal in patients with or without diabetes who present with acute coronary syndromes (ACS). Recognition and treatment of inpatient hyperglycemia remains suboptimal in the majority of US hospitals. In a recent survey of hospitalized patients with acute myocardial infarction (AMI) and hyperglycemia in the presence or absence of type 2 diabetes mellitus (T2DM), 78% of patients with T2DM had mean blood glucose levels >140 mg/dL during hospitalization, as did 26% of nondiabetics, putting them at a significant risk for increased mortality. Not only was hyperglycemia common, but appropriate treatment with intravenous insulin was implemented in only 8% of T2DM patients and 5% of nondiabetics. Despite findings from prior studies, many gaps in knowledge exist on the association between elevated glucose levels and adverse outcomes in ACS patients. A recent AHA scientific statement highlighted the fact that there is no consensus on precise glucose values (or ranges of value) that should be considered abnormal on admission. In addition, there is no consensus on what initial and subsequent methods of measuring and monitoring blood glucose should be, and even when treatment is initiatied, application of an appropriate insulin adminstration protocol is lacking. The lack of consensus in all of these measures is evident across the US and will be discussed in this activity.
Learning Objectives:	a. Understand critical knowledge gaps between hyperglycemia and poor CV outcomes b. Develop optimal ways of measuring and tracking glucose values during ACS hospitalization c. Recognize physiological mechanisms responsible for poor outcomes associated with hyperglycemia d. Address practical aspects of glucose monitoring and management in patients with/without diabetes and AMI e. Engage healthcare team (cardiologists, endocrinologists, critical care nurses, etc) to implement insulin protocols more efficiently
Faculty Disclosure:	The University of Florida College of Medicine has a conflict of interest policy that requires course faculty to disclose any real or apparent commercial financial affiliations related to the content of their presentations/materials. It is not assumed that these financial interests or affiliations will have an adverse impact on faculty presentations; they simply are noted here to fully inform participants. The Faculty, Nurse Champions and Steering Committee have provided The University of Florida College of Medicine with their disclosures, which are available upon request.
Continuing Medical Education Credit:
	Accreditation
	The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
	Credit
	The University of Florida College of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
	This continuing education activity was planned in accordance with the ACCME essentials and reviewed by Carl J. Pepine, MD, Program Chair.
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Commercial Support:	This CME activity is supported by an educational grant from sanofi-aventis U.S.
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CME Contact:	For any question regarding this Internet CME activity, please contact the Office of Continuing Medical Education at 352-265-8081.
	The University of Florida College of Medicine has received permission to use this copyrighted material within a CME activity on the internet.

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