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DIGAMI
Diabetes mellitus Insulin-Glucose infusion in Acute Myocardial Infarction
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Author(s) |
Malmberg K, Rydén L, Efendic S, Herlitz J, Nicol P, Waldenström A, Wedel H, Welin L
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Title(s) |
Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study: effects on mortality at 1 year
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Reference(s) |
J Am Coll Cardiol 1995;26:57-65
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Disease |
Diabetes mellitus, AMI
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Purpose |
To test the hypothesis that rapid improvement of metabolic control in diabetic patients with AMI by means of insulin-glucose infusion decreases the high initial mortality rate and that good metabolic control during the early postinfarction period improves the subsequent prognosis
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Study design |
Randomised, controlled
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Follow-up |
12 months
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Patients |
620 patients (306 insulin-glucose infusion, 314 conventional therapy) with suspected AMI combined with blood glucose > 11 mmol/l
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Treatment regimen |
Insulin-glucose infusion followed by multidose subcutaneous insulin for ≥ 3 months, or conventional therapy
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Concomitant therapy |
Standard coronary care, including thrombolysis, and iv and oral metoprolol
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Results |
The 2 groups' baseline characteristics were comparable. Blood glucose decreased from 15.4 ± 4.1 to 9.6 ± 3.3 mmol/l in the infusion group during the first 24 h, and from 15.7 ± 4.2 to 11.7 ± 4.1 among control patients (p = 0.0001). After 1 year, 57 patients (18.6%) in the infusion group and 82 (26.1%) in the control group had died (relative mortality reduction 29%, p = 0.027). The mortality reduction was particularly evident in patients with a low cardiovascular risk profile and no previous insulin treatment (3-month mortality rate 6.5% in the infusion group vs 13.5% in the control group; relative reduction 52%, p = 0.046; 1-year mortality rate 8.6% in the infusion group vs 18% in the control group; relative reduction 52%, p = 0.20)
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