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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Patients then received insulin-glucose infusions or standard diabetes care according to the study’s protocol Figure 1. Morbidity and mortality were assessed in the acute, sub-acute, and chronic phases.
Decreased insulin sensitivity causes impaired glucose utilization and increased free fatty acid turnover in cardiac muscle. To place the DIGAMI results in perspective, it is important digamu note the decrease in overall mortality in diabetic patients with MI in all treatment groups. In reviewing this study’s population, patients who were not willing or able to commit to insulin were excluded. Adapted from reference 1.
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. 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.
Overall, patients had a mortality of Though unavoidable, this bias should be taken into consideration before making insulin therapy the standard of care. This advantage likely cannot be accounted for by the insulin-glucose infusion protocol alone. Mortality prediction in diabetic patients with myocardial infarction: Development of new Q waves in 2 of the 12 standard electrocardiogram leads.
Overall, concomitant therapy was similar between both groups of the study. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction: Based on these multifaceted benefits of insulin, a multicenter trial was recently performed in Sweden to evaluate the effects of digaji insulin and glucose infusions in diabetic patients who were experiencing an acute MI. During an acute MI, multiple hormonal and physiological changes occur. Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents: Interestingly, the patients who appeared to have the least baseline disease benefited most from aggressive therapy.
Patients who were randomized to the control group were managed according to standard coronary care practice without insulin-glucose infusion.
Health economic benefits and quality of life during improved glycemic control in patients with diabetes mellitus: Initial metabolic and hormonal response to acute myocardial infarction: In this group, insulin troal given in both the acute setting insulin-glucose infusion as well as throughout the year following the MI subcutaneous insulin. When viewed with other browsers, some characters or attributes may not be rendered correctly. Metabolism 41 Suppl 1: People with diabetes who suffer an acute myocardial infarction MI are at markedly increased risk of future cardiovascular morbidity and mortality.
This in itself digmi have created a bias because the patients studied were required to agree to aggressive insulin therapy for an extended period of time.
D espite many advances in modern medicine, diabetes mellitus continues to be associated with increased morbidity and mortality. Insulin therapy has been shown to decrease tPAi-1 levels and possibly normalize the fibrinolytic process. Insulin infusion in diabetic patients with acute myocardial infarction. Characteristics such as compliance and willingness may affect a patient’s success in following intensive insulin therapy for any period of time.
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.
DIGAMI-2 TRIAL –
Plasma catecholamines, glucagon, and cortisol increase, resulting in insulin resistance. High cardiac risk was determined by two or more of the following: Eur Heart J 9: Myocardial infarction in patients with diabetes mellitus. Although improvements have been made in the treatment of cardiac disease, diabetic patients with acute MI continue to have a poor prognosis. Thromboxane A production and platelet aggregability have been shown to be increased in diabetic patients, fostering a hypercoagulable state.
The authors of the DIGAMI study addressed this possible discrepancy, stating that any increased follow-up should be considered part of comprehensive aggressive diabetic management.
These processes not only leave these 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. Jennifer Cummings, MD, is an internal medicine resident.
The leading cause of death in people with diabetes continues to be myocardial infarction MI. Hospital stay was slightly different in that the average length of stay was This study did not provide data showing a direct relationship between insulin-glucose infusion and the decreased mortality at 1 year. There is also a possibility that in the course of implementing prolonged intensive insulin therapy, digamj had increased follow-up appointments and continuing care visits with triak outpatient physicians.
Regulation of glucose uptake in muscle. Kevin Mineo, MD, is is an internal medicine intern. The benefits of beta-blockade, specifically in diabetic patients, are multifaceted in nature. Metabolism of free fatty acids, glucose, and catacholamines in acute myocardial infarction: