Because NICE-SUGAR149 enrolled critically ill medical and surgical patients, the degree to which its results can be extrapolated to the management of patients with UA/ NSTEMI is unclear. Although recent data from a small, mechanistic clinical trial155 suggest that glucose control may reduce inflammation and improve left ventricular ejection fraction in patients with acute MI, it remains uncertain whether acute glucose control will improve patient outcomes. A consensus statement by the American Association of Clinical Endocrinologists and the American Diabetes Asso- ciation157 summarized that although hyperglycemia is asso- ciated with adverse outcomes after acute MI, reduction of glycemia per se and not necessarily the use of insulin is Table 6. Recommendations for Warfarin Therapy 2012 Focused Update Recommendations 2012 Comments Class I 1. Use of warfarin in conjunction with aspirin and/or P2Y12 receptor inhibitor therapy is associated with an increased risk of bleeding, and patients and clinicians should watch for bleeding, especially GI, and seek medical evaluation for evidence of bleeding.7,9,13,14,141 144 (Level of Evidence: A) modified ( thienopyridine replaced with P2Y12 receptor inhibitor ). Class IIb 1. Warfarin either without (INR 2.5 to 3.5) or with low-dose aspirin (81 mg per day; INR 2.0 to 2.5) may be reasonable for patients at high coronary artery disease risk and low bleeding risk who do not require or are intolerant of P2Y12 receptor inhibitor therapy.145,146 (Level of Evidence: B) modified ( thienopyridine replaced with P2Y12 receptor inhibitor ). 2. Targeting oral anticoagulant therapy to a lower INR (eg, 2.0 to 2.5) might be reasonable in patients with UA/NSTEMI managed with aspirin and a P2Y12 inhibitor. (Level of Evidence: C) New recommendation GI indicates gastrointestinal; INR, international normalized ratio; and UA/NSTEMI, unstable angina/non ST-elevation myocardial infarction. Table 7. Recommendations for Diabetes Mellitus 2012 Focused Update Recommendations 2012 Comments Class I 1. 