Practice Guidelines

Hyperglycaemia in acute coronary syndromes: summary of NICE guidance

BMJ 2011; 343 doi: (Published 26 October 2011) Cite this as: BMJ 2011;343:d6646
  1. A Senthinathan, technical analyst,
  2. V Kelly, project manager,
  3. M Dzingina, technical analyst (health economics),
  4. D Jones, technical adviser,
  5. M Baker, clinical adviser,
  6. D Longson, chair of the Guideline Development Group
  7. On behalf of the Guideline Development Group
  1. 1National Institute for Health and Clinical Excellence, Short Clinical Guidelines, Manchester M1 4BD, UK
  1. Correspondence to: Dr Damien Longson, Manchester Mental Health and Social Care Trust, Department of Psychiatry, Manchester M8 5RB, UK damien.longson{at}

Hyperglycaemia is common in patients who are admitted to hospital with acute coronary syndrome. In the Euro Heart Survey on diabetes, 22% of people admitted to hospital as emergency cases because of coronary artery disease were found to have undiagnosed diabetes after a glucose tolerance test, with a further 36% found to have impaired glucose tolerance.1 Hyperglycaemia is a powerful predictor of poorer survival and increased risk of complications while in hospital.2 3 Despite this, hyperglycaemia remains under-recognised as a risk factor for acute coronary syndrome and is often untreated.4 This article summarises the recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of hyperglycaemia within the first 48 hours of a patient’s admission to hospital for acute coronary syndrome.5


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Managing hyperglycaemia in inpatients within 48 hours of acute coronary syndrome

  • Manage hyperglycaemia (blood glucose concentration >11.0 mmol/L) in patients admitted to hospital for acute coronary syndrome by keeping blood glucose concentrations to below 11.0 mmol/L while avoiding hypoglycaemia. Initially, consider a dose adjusted insulin infusion with regular monitoring of blood glucose concentrations. [Based …

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