When viewed with other browsers, some characters or attributes may not be rendered correctly. From Research to Practice and Coronary Heart Disease In Brief People with diabetes who suffer an acute myocardial infarction MI are at markedly increased risk of future cardiovascular morbidity and mortality. 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. Although there was an overall reduction in adverse outcomes in patients receiving the intensive insulin regimen, it is unclear which component the IV insulin infusion or the intensive chronic therapy was responsible. Josephson, MS, MD Despite many advances in modern medicine, diabetes mellitus continues to be associated with increased morbidity and mortality.
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Print Image: PD 1. In diabetic patients with acute myocardial infarction, insulin-glucose infusion with subsequent long-term insulin treatment reduces mortality at 1 year. This difference remained despite the introduction of new therapeutic measures, such as beta-blockers. Increased fatty acid metabolism in diabetes is thought to decrease the anaerobic process of glycolysis that is important for the survival of ischemic tissue.
The DIGAMI study showed that, in diabetic patients already receiving beta-blockers and thrombolytic treatment, metabolic control via an insulin-glucose infusion and long-term insulin therapy further decreased post-MI mortality after 1 year. It is unclear from the study results whether the immediate insulin-glucose infusion or the subsequent multidose insulin therapy is most responsible for the decrease in post-MI mortality.
The lack of free fatty acid measurements also limits the study from clarifying the mechanism of benefit from insulin treatment post-MI.
Only half of the 1, eligible patients were randomized for the study, resulting in a relatively small sample size, wide confidence intervals, and potential bias due to the exclusion of patients unwilling to undergo aggressive insulin therapy. All patients received thrombolytic treatment i.
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Search Menu Aims Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. In DIGAMI 2, three treatment strategies were compared: group 1, acute insulin—glucose infusion followed by insulin-based long-term glucose control; group 2, insulin—glucose infusion followed by standard glucose control; and group 3, routine metabolic management according to local practice. The primary endpoint was all-cause mortality between groups 1 and 2, and a difference was hypothesized as the primary objective. The secondary objective was to compare total mortality between groups 2 and 3, whereas morbidity differences served as tertiary objectives. The median study duration was 2. At randomization, HbA1c was 7. Blood glucose was significantly reduced after 24 h in all groups, more in groups 1 and 2 9.
DIGAMI 2 trial post hoc analysis: Lessons in overinterpretation
This is precisely what Mellbin and associates have done. Finally, use of secondary end points in post hoc analyses, especially when they were negative in the original report, is especially prone to overinterpretation. All of the differences in the current report are related to the secondary end points, even though the authors of the original DIGAMI 2 study did not report any differences in these secondary end points. Why does this approach raise such a serious concern? Finally, statistical adjustment for multiple variables is markedly limited with a small number of events.
The DIGAMI trial: Insulin-glucose infusion in diabetics with acute MI [Classics Series]