Problem DM in acute MI
Format Double-blinded multi-center RCT
Treatment Insulin infusion then either insulin OR standard treatment
Control Routine DM therapy throughout
Population 1,253 patients
Inclusion criteria Patients with established type 2 diabetes or an admission blood glucose >11.0 mmol/L, admitted to participating coronary care units, were eligible for inclusion according to the following criteria: suspect acute myocardial infarction due to symptoms (chest pain >15 min during the preceding 24 h) and/or recent ECG signs (new Q-waves and/or ST-segment deviations in two or more leads).
Exclusion criteria Exclusion criteria were inability to cope with insulin treatment or to receive information on the study; residence outside the hospital catchment area; participation in other studies, or previous participation in DIGAMI 2. The study conformed to good clinical practice guidelines and followed the recommendations of the Helsinki Declaration. Local ethics review boards approved the protocol. Written informed consent was obtained from all patients prior to enrolment.
Follow-up Median 2.1 years
Primary endpoint Total mortality between continued insulin versus early insulin only
Secondary endpoint(s) Total mortality between early insulin only and normal local management
Details .
Brief summary: Longer-term insulin shows no advantage, but glucose levels predict mortality well
PAPER: Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity.
Date 26 Apr 2005
Journal Eur Heart J. 2005 Apr;26(7):650-61. Epub 2005 Feb 23.
Information -NO evidence that long-term insulin improves survival or re-infarction/stroke compared with a conventional management at similar levels of glucose control.
-Glucose level is a strong, independent predictor of long-term mortality