Piloting a Novel Algorithm for Glucose Control in the Coronary Care Unit The RECREATE (REsearching Coronary REduction by Appropriately Targeting Euglycemia) trial

OBJECTIVEdElevated glucose levels are common after an acute myocardial infarction (AMI) and increase the risk of death. Prior trials of glucose control after AMI have been inconsistent in their ability to lower glucose levels and have reportedmixed effects onmortality.We developed a paper-based glucose-lowering algorithm and assessed its feasibility and safety in the setting of AMI. RESEARCH DESIGN AND METHODSdA total of 287 participants with an acute ST segment elevation myocardial infarction (STEMI) and a capillary glucose level $8.0 mmol/L were randomly allocated to glucose management with intravenous glulisine insulin using this algorithm in the coronary care unit (CCU), followed by once-daily subcutaneous insulin glargine for 30 days versus standard glycemic approaches. The primary outcome was a difference in mean glucose levels at 24 h. Participants were followed for clinical outcomes through 90 days. RESULTSdAt 24 h, the mean glucose level was 1.41 mmol/L (95%CI 0.69–2.13) lower in the insulin (6.53 vs. 7.94mmol/L). Differences in glucose levels weremaintained at 72 h and 30 days. A total of 22.7 % of the insulin group versus 4.4 % of the standard group had biochemical hypoglycemia (with neither signs nor symptoms) in the CCU because of lower glycemic goals. However, there were no differences in symptomatic hypoglycemia or clinical outcomes betwee