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To the Editor: Metabolic modulation of the myocardium using a fixed-dose GIK infusion can result in acute hyperglycemia, which may have led to the early harmful effects of GIK therapy in the CREATE-ECLA and OASIS-6 trials by Dr Díaz and colleagues.¹ Hyperglycemia reduces spontaneous reperfusion, decreases microvascular perfusion, and has detrimental effects on left ventricular remodeling after MI.² An insulin infusion of 2.5 units per hour in acute MI while maintaining glycemic control (glucose level <140 mg/dL [to convert to mmol/L, multiply by 0.0555]) is associated with an anti-inflammatory, profibrinolytic, antioxidant, and cardioprotective effect.³ Insulin also has antiapoptotic effects; in a canine model of acute MI, low-dose insulin alone reduced myocardial infarct size while glucose and potassium led to hyperglycemia and increased infarct size.⁴

Therefore, potential mechanisms exist by which any cardiovascular benefits of insulin can be negated by GIK-induced hyperglycemia. Although the early harmful effects of GIK have been . . . [Full Text of this Article]

Ajay Chaudhuri, MD
Kaleida Health
Buffalo, New York

Richard Nesto, MD
Harvard Medical School
Boston, Massachusetts

Paresh Dandona, MD, PhD
pdandona@kaleidahealth.org
Kaleida Health

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