The DIGAMI study compared “conventional” anti-diabetic therapy to intensive insulin therapy consisting of acute insulin infusion during the early hours of MI and. On the basis of these findings, the Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) trial was started. View fulltext. DIGAMI 1 was a prospective, randomised, open-label trial with blinded endpoint evaluation (PROBE) done at coronary care units in
|Published (Last):||12 August 2004|
|PDF File Size:||14.14 Mb|
|ePub File Size:||6.80 Mb|
|Price:||Free* [*Free Regsitration Required]|
This is an important consideration especially when contemplating implementing this protocol. The authors of the DIGAMI study addressed this possible discrepancy, stating that any increased follow-up should be considered part of comprehensive aggressive diabetic management. The heart’s demand for more oxygen cannot be met by the blood supply because of the infarction process. The change in mortality during hospitalization and at 3 months post-MI was not significant.
This in itself may have created a bias because the patients studied were required to agree to aggressive insulin therapy for an extended period of time. Health economic benefits and cigami of life during improved glycemic control in patients with diabetes mellitus: Insulin infusion in trixl patients with acute myocardial infarction. Intensive insulin therapy included an insulin-glucose infusion during the initial 24 hours of hospitalization, followed by subcutaneous insulin four times daily for a minimum of 3 months.
Instead, it showed a decreased mortality in diabetic patients admitted with MIs when given an intensive insulin regimen extending from admission up to 1 year. Metabolism 41 Suppl 1: Digamo pre-stratified risk groups were 1 no previous insulin; low cardiac risk, 2 previous insulin; low cardiac risk, 3 no previous insulin; high cardiac risk, and 4 previous insulin; high cardiac risk.
A final point to emphasize in reviewing the DIGAMI results is the significant mortality reduction noted in patients who were never previously on insulin and who had low cardiac risk factors. Mortality and morbidity during five year follow-up of diabetics with myocardial infarction.
There is also a possibility that in the course of implementing prolonged intensive insulin therapy, patients had increased follow-up appointments and continuing care visits with their outpatient physicians.
N Engl J Med The effect of intensive treatment of diabetes on the diigami and progression of long-term complications in insulin-dependent diabetes mellitus. Insulin therapy has been shown to decrease tPAi-1 levels and possibly normalize the fibrinolytic process. Overall, concomitant therapy was similar between both groups of the study. The purpose of the DIGAMI study was to evaluate whether aggressive initial insulin therapy continued for 3 months would improve these patients’ morbidity and mortality following an acute MI.
The higher death and complication diggami in these diabetic patients appear to be multifactorial.
DIGAMI-2 TRIAL –
Adapted from reference 1. To place the DIGAMI results in perspective, it is important to note the decrease in overall mortality in diabetic patients with MI in all treatment groups. Though unavoidable, this bias should be taken into consideration before making insulin therapy the standard of care.
These trual not only leave these diabetic patients at higher risk of death when having an acute MI, but also increase their risk of recurrent cardiac events and other long-term complications. J Biol Chem Summary of Results Group characteristics The control group and the infusion group had similar demographics and pre-hospitalization characteristics. In Brief People with diabetes who suffer an acute myocardial infarction MI are at markedly increased risk of future cardiovascular morbidity and mortality.
Though trkal may help reduce mortality in theory, a treatment plan that patients are willing and able to perform may achieve more long-term success. This shift from glucose use to free fatty acid use increases the oxygen demand of the heart muscle. The DIGAMI study compared “conventional” anti-diabetic therapy to intensive insulin therapy consisting of acute insulin infusion during the early hours of MI and thrice-daily subcutaneous insulin injection for the remainder of the hospital stay and a minimum of 3 months thereafter.
This impairment may potentiate ischemic heart disease by facilitating coronary artery occlusion and reocclusion. Kevin Mineo, MD, is is an internal medicine intern. Overall, this study was eigami in showing the feasibility and potential advantage of aggressive long-term insulin management in diabetic patients with MIs.
Clinical course of myocardial infarction among diabetic patients. The remaining patients were then randomized to either a control group patients or an insulin infusion group patients.
Patients then received trlal infusions or standard diabetes care according to the study’s protocol Figure 1.
Though the infusion group had a slightly lower mortality than the control group in the hospital 9. Initial metabolic and hormonal response to acute myocardial infarction: Thus, some researchers believe diabetic patients may show a greater benefit when heart rate, and thus myocardial oxygen demand, is decreased. People with diabetes are more sensitive to catacholamine stimulation, and thus they have a dramatic increase in plasma free fatty acids and a decrease in glucose utilization.
Mortality prediction in diabetic patients with myocardial infarction: These benefits of intensive treatment were greater in the primary prevention group, whose subjects had no symptoms at baseline.
Glucose does not require oxygen when metabolized glycolysisbut this process, as described above, is impaired by the hormonal changes that take place during MI. One such dysfunction is the increased platelet aggregation, which can be reduced with insulin administration.
Feasibility of insulin glucose infusion in diabetic patients with acute myocardial infarction. Thus, regardless of the treatment protocol received, the in-hospital courses were similar. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction DIGAMI study: The diagnosis of MI was divided into probable or possible using conventional criteria Table 1.
Amsterdam, Elsevier,p. Metabolism of free fatty acids, glucose, and catacholamines in acute myocardial infarction: Effects of insulin treatment on cause specific one-year mortality and morbidity in diabetic patients with acute myocardial infarctions. Studies have shown that insulin may have a role in restoring other cardiac and metabolic dysfunctions common in diabetic patients. The leading cause of death in people with diabetes continues to be myocardial infarction MI.
Some credit the overall improvement to widespread use of medications, such as beta-blockers, aspirin, and thrombolytics. Other cardiac medications now widely used that may have had an effect on overall diabetic MI mortality are aspirin and thrombolytics.
This advantage likely cannot be accounted for by the insulin-glucose infusion protocol alone.