Role of insulin-glucose infusion in outcomes after acute myocardial infarction: the diabetes and insulin-glucose infusion in acute myocardial infarction (DIGAMI) study.
OBJECTIVE
To review the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study for findings regarding effects on morbidity and mortality.


RESULTS
The DIGAMI trial was an intervention study that tested the hypothesis that initial intensive metabolic control by insulin-glucose infusion for at least 24 hours followed by long-term treatment with subcutaneously administered insulin improved the prognosis in patients with diabetes and acute myocardial infarction. Overall, the intensive approach reduced the long-term relative mortality (at 3.4 years of follow-up) by 25% in the insulin-treated group. Improved long-term survival was especially evident in the prestratified group of patients without prior insulin treatment, in whom the 3.4-year mortality reduction was 45%. Furthermore, a close correlation was noted between high blood glucose level at admission and mortality among the patients in the control group; this relationship was attenuated by intensive insulin treatment.


CONCLUSIONS
The DIGAMI study supports the theory that intensive metabolic care in patients with diabetes who have had an acute myocardial infarction improves the prognosis. The study, however, could not answer whether this result was due to the initial insulin-glucose infusion or to the long-term subcutaneous treatment with insulin. This question is currently being addressed in the DIGAMI-2 study.
Malmberg
Klas
K
Department of Cardiology, Karolinska Institutet, Stockholm, Sweden.
D001786:Blood Glucose / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D004334:Drug Administration Schedule; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015994:Incidence; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D016019:Survival Analysis
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose