The correct answer is:

Blood glucose level should be maintained below 180 mg/dL while avoiding hypoglycemia

Educational Objective:

Manage non-ST elevation acute coronary syndrome in patients with diabetes mellitus.

Key Point:

Blood glucose should be controlled to a level below 180 mg/dL while avoiding hypoglycemia.

Explanation:

Blood glucose should be maintained at a level below 180 mg/dL while avoiding hypoglycemia. The 2014 practice guidelines for NSTE-ACS reaffirm the previous recommendation from 2012 for moderate glucose control with maintenance of blood glucose to a level below 180 mg/dL while avoiding hypoglycemia. Both hyperglycemia and hypoglycemia have been found to increase mortality in patients with diabetes mellitus and acute coronary syndrome. One trial revealed that intensive glucose control (target goal, 81-108 mg/dL) resulted in increased mortality and hypoglycemia when compared with moderate glucose control (target goal < 180 mg/dL).

The 2014 practice guidelines for NSTE-ACS also recommend that treatment decisions and medical treatment options be similar for patients with or without diabetes in the acute phase of NSTE-ACS (class I recommendation). This includes use of glycoprotein IIb/IIIa inhibitors as indicated, percutaneous coronary intervention for single-vessel disease, and coronary artery bypass graft surgery for patients with multivessel disease.

The threshold to proceed with cardiac catheterization may or may not be affected by the presence of diabetes. One of the TIMI score categories adds a point if a patient has 3 or more of the following cardiac risk factors: diabetes, hypercholesteremia, hypertension, family history of CAD, or current smoker. Diabetes by itself will not affect the TIMI score, but it adds weight to the “3 or more cardiac risk factors” point in the TIMI score. 

Follow this link to an online TIMI score calculator.