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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Though the infusion group had a slightly lower mortality than the control group in the hospital 9. 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. Insulin infusion in diabetic patients with acute myocardial infarction.
Though insulin may help reduce mortality in theory, a treatment plan that patients are willing and able to perform may achieve digqmi long-term success.
Regulation of glucose uptake in muscle. Interestingly, the patients who appeared to have the least baseline disease benefited most from aggressive therapy. The higher death and complication rates in these diabetic patients appear to be multifactorial.
In the past, beta-blockers were not used in diabetic patients for fear of masking and possibly prolonging of hypoglycemic episodes.
Morbidity and mortality were assessed in the acute, sub-acute, and chronic phases. The diagnosis of MI was divided into probable or possible using conventional criteria Table 1.
One such dysfunction is the increased platelet aggregation, which can be reduced with insulin administration. Relation between serum free fatty acids and arrhythmias and death after acute myocardial infarctions.
DIGAMI-2 TRIAL –
Studies have shown that insulin may have a role in restoring other cardiac and metabolic dysfunctions common in diabetic patients.
Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction: Conclusion Diabetes continues to adversely affect the prognosis in individuals presenting with MI. In this group, insulin was given in both the acute digamii insulin-glucose infusion as well as throughout the year following the MI subcutaneous insulin.
In Brief People with diabetes who suffer an acute myocardial infarction MI are at markedly increased risk of future cardiovascular morbidity and cigami.
Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction DIGAMI study: Overall, this study was successful in showing the feasibility and potential advantage of aggressive long-term insulin management in diabetic patients with MIs.
By preferentially using glucose, myocardial oxygen demand decreases, and the supply-demand imbalance may be reduced. Jennifer Cummings, MD, is an internal medicine resident. Metabolism 41 Suppl 1: This impairment may potentiate ischemic heart disease by facilitating coronary artery occlusion and reocclusion.
Characteristics such as compliance and willingness may affect a patient’s success in following intensive insulin therapy for any period of time. Other cardiac medications now widely used that may have had an effect on overall diabetic MI mortality are aspirin and thrombolytics. The heart’s demand for more oxygen cannot be met by the blood supply because of the infarction process. When considering treating diabetic patients in such an aggressive manner using insulin, other social needs should be considered.
These actions of insulin appear to reduce many of the biochemical obstacles diabetic patients face during and after MI. Overall, concomitant therapy was similar between both groups of the study. During an acute MI, multiple hormonal and physiological changes occur. 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.
Plasminogen activator in plasma, risk factor for recurrent myocardial infarction. The infusion was continued for a minimum of 24 hours, at which point the patients were changed to subcutaneous insulin injections 4 times daily.
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 with MIs at 1 year.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. 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.
Patients then received insulin-glucose infusions or standard diabetes care according to the study’s protocol Figure 1. This advantage likely cannot be accounted for by the insulin-glucose infusion protocol alone. Glucose does not require oxygen when metabolized glycolysisbut this process, as described above, is impaired by the hormonal changes that take place during MI.
Diabetes may be associated with severe coronary artery disease, systolic tral ventricular dysfunction, autonomic neuropathy, and larger infarct size.