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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It is reasonable to propose that increased anti-platelet and fibrinolytic therapy may have aided in the overall decreased mortality in the diabetic patients with cardiac events included in this study.
In reviewing this study’s population, patients who were not willing or able to commit to insulin were excluded.
Overall, patients had a mortality of Insulin therapy has been shown to decrease tPAi-1 levels and possibly normalize the fibrinolytic process. The authors of the DIGAMI study addressed this possible discrepancy, stating that any increased follow-up should be considered part dibami comprehensive aggressive diabetic management.
This supply-demand imbalance creates an energy deficit that leads to myocardial ischemia. 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 benefits of beta-blockade, specifically in diabetic patients, are multifaceted in nature.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. Regulation of ddigami uptake in muscle. The heart’s demand for more oxygen cannot be met by the blood supply because of the infarction process. The leading cause of death in people with diabetes continues to be myocardial infarction MI.
Although there was an overall reduction in adverse outcomes in trual receiving the intensive insulin regimen, it is unclear which component the IV insulin infusion or the diagmi chronic therapy was responsible.
Initial metabolic and hormonal response to acute myocardial infarction: Health economic benefits and quality of life during improved glycemic control in patients with diabetes mellitus: This change in metabolism would decrease myocardial muscle oxygen requirements, shifting the supply-demand imbalance and possibly reducing infarction size.
This shift from glucose use to free fatty acid use increases the oxygen demand of the heart muscle.
Conclusion Diabetes continues to adversely affect the prognosis in individuals presenting with MI. Overall, this study was successful in showing the feasibility and potential advantage of aggressive long-term insulin management in diabetic patients with MIs. Postgrad Med J 52 Suppl 4: When examining mortality in the pre-stratified risk groups, the greatest mortality reduction is noted for patients who had never been on insulin before and were classified as low cardiac risk.
Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents: Some credit the overall improvement to widespread use of medications, such as beta-blockers, aspirin, and thrombolytics.
By preferentially using glucose, myocardial oxygen demand decreases, and the supply-demand imbalance may be reduced. During an acute MI, multiple hormonal and physiological changes occur. Patients who were randomized to the control group were managed according to standard coronary care practice without insulin-glucose infusion.
Eur Heart J 9: Interestingly, the patients who appeared to have the least baseline disease benefited most from aggressive therapy. 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.
Morbidity and mortality were assessed in the acute, sub-acute, trual chronic phases. In Diabetes and Heart Disease. Diabetes may be associated with severe coronary artery disease, systolic left ventricular dysfunction, autonomic neuropathy, and larger infarct size.
Jennifer Cummings, MD, is an internal medicine resident. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction: Insulin, either endogenous or exogenous, favors the use of glucose rather than free fatty acids as an energy source. This makes determining which intervention was responsible for the decrease in mortality impossible: People with diabetes are more sensitive to catacholamine stimulation, and thus they have a dramatic increase in triial free fatty acids and a decrease in glucose utilization.
This increase in mortality is shown during both initial hospitalization and long-term follow up. Acute myocardial infarction figami the diabetic patient: 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.
There are indications in experimental settings that propranolol may shift myocardial metabolism from free fatty acid utilization rigami glucose utilization. Relation between serum free fatty acids and arrhythmias and death after acute myocardial infarctions. Adapted from reference 1. 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.
Tgial randomized study of intensive insulin treatment of long-term survival after acute myocardial infarction in patients with diabetes mellitus.
DIGAMI-2 TRIAL –
Mortality and morbidity during five year follow-up of diabetics with myocardial infarction. Overall, concomitant therapy was similar between both groups of the study. Subcutaneous insulin was used only if determined to be necessary by a CCU physician, particularly if the patient was on insulin before admission. In addition to the diabetes treatment, all patients received thrombolytic therapy streptokinasebeta-blockers, aspirin, heparin, nitroglycerin, percutaneous transluminal coronary angioplasty PTCAand coronary artery bypass graft CABG surgery acutely and chronically as deemed appropriate by their physicians.
Kevin Mineo, MD, is is an internal medicine intern.