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
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Diabetes may be associated with severe coronary artery disease, systolic left ventricular dysfunction, autonomic neuropathy, and larger infarct size.
Hospital stay was slightly different in that the average length of stay was 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. The authors of the DIGAMI study addressed rtial possible discrepancy, stating that any increased follow-up should be considered part of comprehensive aggressive diabetic management.
Feasibility of insulin glucose infusion in diabetic patients with acute myocardial infarction. J Am Coll Cardiol This study ditami not provide data showing a direct relationship between insulin-glucose infusion and the decreased mortality at 1 year. The heart’s demand for more oxygen cannot be met by the blood supply because of the infarction process.
Discussion Patients with diabetes not only are at increased risk of having an MI, but also are more likely to have complications, increased mortality, and recurrent infarctions. This increase in mortality tfial shown during both initial hospitalization and long-term follow up. In reviewing tria study’s population, patients who were not willing or able to commit to insulin were excluded. Thus, regardless of the treatment protocol received, the in-hospital courses were similar.
A final point to emphasize in reviewing the DIGAMI results is the significant mortality reduction tria, in patients who were never previously on insulin and who had low cardiac risk factors. Other cardiac medications now widely used that may have had an effect on overall diabetic MI mortality are aspirin and thrombolytics. The higher death and complication rates in these diabetic patients appear to be multifactorial. Kevin Mineo, MD, is is an internal medicine intern. This change in metabolism would decrease myocardial muscle oxygen requirements, shifting the supply-demand imbalance and trixl reducing infarction size.
This advantage likely cannot be accounted for by the insulin-glucose infusion protocol alone.
In Diabetes and Heart Disease. 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.
This supply-demand imbalance creates an energy deficit that leads to myocardial ischemia. Eur Heart J 9: Adapted from reference 1.
Overall, concomitant therapy was similar between both groups of the study. In the past, beta-blockers were not used in diabetic patients trlal fear of masking and possibly prolonging of hypoglycemic episodes.
Studies have shown that insulin may have a role digaami restoring other cardiac and metabolic dysfunctions common in diabetic patients. Though other studies have evaluated the relationship between improved diabetic control and post-MI morbidity and mortality, the DIGAMI study is the first to show such a large reduction in mortality for diabetic patients triaal MIs at 1 year.
Conclusion Diabetes continues to adversely affect the prognosis in individuals presenting with MI. D espite many advances in modern medicine, diabetes mellitus continues to be associated with increased morbidity and mortality.
Jennifer Cummings, MD, is an internal medicine resident. Prospective randomized study of intensive insulin treatment of long-term survival after acute myocardial infarction in patients with diabetes mellitus.
Initial metabolic and hormonal response to acute myocardial infarction: Mortality and morbidity during five year follow-up of diabetics with myocardial infarction.
Characteristics such as compliance and willingness may affect a patient’s success in following intensive insulin therapy for any period of time. Effects of metoprolol on mortality and late infarction digamk diabetics with suspected acute difami infarction: This shift from glucose use to free fatty acid use increases the oxygen demand of the heart muscle.
These processes not only leave dihami 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.
DIGAMI-2 TRIAL –
This is an important consideration digaki when contemplating implementing this protocol. The purpose triao 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.
This makes determining which intervention was responsible for the decrease in mortality impossible: Digmi A production and platelet aggregability have been shown to be increased in diabetic patients, fostering a hypercoagulable state. 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. This impairment may potentiate ischemic heart disease by facilitating coronary artery occlusion and reocclusion.
These benefits of intensive treatment were greater in the primary prevention group, whose subjects had no symptoms at baseline.
Subcutaneous insulin was triql only if determined to be necessary by a CCU physician, particularly if the patient was on insulin before admission. Glucose does not require oxygen when metabolized glycolysisbut this process, as described above, is impaired by the hormonal changes that take place during MI.
The 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 trual risk. J Biol Chem This type of commitment may not be possible in a portion of the population due to either inability or unwillingness to administer insulin. In implementing this protocol, a patient should be willing to commit to both an acute and a long-term intervention program to fully improve their mortality.
Though the infusion group had a slightly lower mortality than the control group in the hospital 9.