Recommendations for Diabetes Mellitus 2012 Focused Update Recommendations 2012 Comments Class I 1. Medical treatment in the acute phase of UA/NSTEMI and decisions on whether to perform stress testing, angiography, and revascularization should be similar in patients with and without diabetes mellitus.55,72,81,147 (Level of Evidence: A) 2007 recommendation remains current. Class IIa 1. For patients with UA/NSTEMI and multivessel disease, CABG with use of the internal mammary arteries can be beneficial over PCI in patients being treated for diabetes mellitus.148 (Level of Evidence: B) 2007 recommendation remains current. 2. PCI is reasonable for UA/NSTEMI patients with diabetes mellitus with single-vessel disease and inducible ischemia.55 (Level of Evidence: B) 2007 recommendation remains current. 3. It is reasonable to use an insulin-based regimen to achieve and maintain glucose levels less than 180 mg/dL while avoiding hypoglycemia* for hospitalized patients with UA/NSTEMI with either a complicated or uncomplicated course.149 152 (Level of Evidence: B) 2011 recommendation remains current. *There is uncertainty about the ideal target range for glucose necessary to achieve an optimal risk-benefit ratio. CABG indicates coronary artery bypass graft; PCI, percutaneous coronary intervention; and UA/NSTEMI, unstable angina/non ST-elevation myocardial infarction. associated with improved outcomes. It remains unclear, however, whether hyperglycemia is a marker of underlying health status or is a mediator of complications after acute MI. Noniatrogenic hypoglycemia has also been associated with adverse outcomes and is a predictor of higher mortality. There is a clear need for a well-designed, definitive random- ized trial of target-driven glucose control in UA/NSTEMI patients with meaningful clinical endpoints so that glucose treatment thresholds and glucose targets can be determined. 