Effect of Strict Glycemic Control in Diabetics with Acute Coronary Syndrome

Obesity and Endogenous Insulin Secretion Affect the Incidence of Coronary Restenosis

Abstract

We investigated whether glycemic control prevents restenosis after percutaneous coronary intervention (PCI). Seventeen poorly controlled diabetic patients with acute coronary syndrome (ACS) who had undergone emergency PCI were selected. We began to educate them and strictly control their plasma glucose level immediately after the onset of ACS, and evaluated them for coronary restenosis by angiography 2-12 months later. The glycohemoglobin Aic level improved from 8.5% to 6.4%(p=0.0001), but 12 patients (70.6%) were diagnosed with restenosis. There were no differences in age, sex, duration of diabetes, or plasma glucose level between the patients with restenosis (R group) and those without restenosis (N group). Baseline urinary C peptide values and BMI were significantly lower in the R group (p=0.04, 0.005). The N group lost more body weight after education than the R group (p=0.04). These findings suggest that glycemic control cannot prevent restenosis in lean patients with impaired insulin secretion, but that glycemic control with body weight loss reduces the incidence of restenosis in obese patients.