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.
OBJECTIVE
We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infarction affected mortality during the subsequent 12 months of follow-up.


BACKGROUND
Despite significant improvements in acute coronary care, diabetic patients with acute myocardial infarction still have a high mortality rate.


METHODS
A total of 620 patients were studied: 306 randomized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for > or = 3 months and 314 to conventional therapy.


RESULTS
The two groups were well matched for baseline characteristics. Blood glucose decreased from 15.4 +/- 4.1 to 9.6 +/- 3.3 mmol/liter (mean +/- SD) in the infusion group during the 1st 24 h, and from 15.7 +/- 4.2 to 11.7 +/- 4.1 among control patients (p < 0.0001). After 1 year 57 subjects (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 who had 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. 18.0% in the control group [relative reduction 52%, p = 0.020]).


CONCLUSIONS
Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infarction.
Malmberg
K
K
Department of Cardiology, Karolinska Hospital, Stockholm, Sweden.
Rydén
L
L
Efendic
S
S
Herlitz
J
J
Nicol
P
P
Waldenström
A
A
Wedel
H
H
Welin
L
L
D000368:Aged; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D016019:Survival Analysis
D007328:Insulin; D005947:Glucose