There is a U-shaped relationship between glucose levels and mortality in patients with diabetes mellitus and ACS.543 Both hyperglycemia and hypoglycemia have similar adverse effects on in-hospital and 6-month mortality. The urgency to aggressively control blood glucose has been moderated by the results of the NICE-SUGAR (Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regimen) trial.608 In this study of patients admitted to medical and surgical intensive care units, intensive glucose control (target 81 mg/dL to 108 mg/dL) resulted in increased all-cause mortality and hypoglycemia com- pared with moderate glucose control (target <l80 mg/dL). Blood glucose should be maintained at <l80 mg/dL while avoiding hypoglycemia. There is no established role for the administration of glucose-insulin-potassium infusions in NSTE-ACS.609 611 Although patients with diabetes mellitus and NSTE-ACS are at higher risk for in-hospital and longer-term events, they undergo less frequent revascularization procedures. In a mul- tinational study of 6385 patients with ACS, 25% of whom had diabetes mellitus, those with diabetes mellitus had more adverse risk profiles, more atypical presentations, longer treat- ment delays, more HF, and renal insufficiency but underwent less angiography and revascularization.607 In the GRACE and other studies,606 patients with diabetes melli- tus and NSTE-ACS in the United Kingdom603 had higher baseline risk profiles but received effective medical cardiac therapies and revascularization less frequently. Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e387 Although there are no RCTs of patients specifically diagnosed with diabetes mellitus andACS, there are ample data on patients with diabetes mellitus treated with PCI or CABG.564,565,613 615 The largest RCT, the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease) trial,616 patients (approximately 30% with recent [interval unspecified] ACS) with 2- or 3-vessel CAD randomized to a DES or CABG. 