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Cited by 1,560Hyperglycemia and glycemic control in critically ill and hospitalized patientsAcute Myocardial Infarction ResearchDiabetes Treatment and Management

Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year

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Malmberg, Klas, Rydén, Lars, Efendic, Suad, Herlitz, Johan, Nicol, Peter, Waldenstrom, Anders, Wedel, Hans, Welin, Lennart·1995·Journal of the American College of Cardiology
DOI 10.1016/0735-1097(95)00126-k
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Abstract

Objectives We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infarction affected mortality during the subsequent 12 months of follow-up.Background Despite significant improvements in acute coronary care, diabetic patients with acute myocardial infarction still have a high mortality rate.Methods A total of 620 patients were studied: 306 randomized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for > or = 3 months and 314 to conventional therapy.Results The two groups were well matched for baseline characteristics. Blood glucose decreased from 15.4 +/- 4.1 to 9.6 +/- 3.3 mmol/liter (mean +/- SD) in the infusion group during the 1st 24 h, and from 15.7 +/- 4.2 to 11.7 +/- 4.1 among control patients (p < 0.0001). After 1 year 57 subjects (18.6%) in the infusion group and 82 (26.1%) in the control group had died (relative mortality reduction 29%, p = 0.027). The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment (3-month mortality rate 6.5% in the infusion group vs. 13.5% in the control group [relative reduction 52%, p = 0.046]; 1-year mortality rate 8.6% in the infusion group vs. 18.0% in the control group [relative reduction 52%, p = 0.020]).Conclusions Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infarction.

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  • Other studies have shown that adequate glycaemic control improves the prognosis of patients with ACS, while also demonstrating the importance of avoiding hypoglycaemia, which is strongly associated with worse outcomes.

    “Other studies have shown that adequate glycaemic control improves the prognosis of patients with ACS, while also demonstrating the importance of avoiding hypoglycaemia, which is strongly associated with worse outcomes.423,424”

    From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [423]

  • Mean blood glucose in the intensive insulin intervention arm of DIGAMI was 172.8 mg/dl, compared with 210.6 mg/dl in the conventional group.

    “Mean blood glucose in the intensive insulin intervention arm was 172.8 mg/dl (9.6 mmol/l), compared with 210.6 mg/dl (11.7 mmol/l) in the “conventional” group.”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [320]

  • The broad range of blood glucose levels within each arm of DIGAMI limits the ability to define specific blood glucose target thresholds.

    “The broad range of blood glucose levels within each arm limits the ability to define specific blood glucose target thresholds.”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [320]

  • In the initial DIGAMI study, insulin-glucose infusion followed by at least 3 months of subcutaneous insulin treatment in diabetic patients with acute myocardial infarction improved long-term survival.

    “In the initial Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study (319,320), insulin-glucose infusion followed by at least 3 months of subcutaneous insulin treatment in diabetic patients with acute myocardial infarction improved long-term survival.”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [320]

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Research works printed but not linked: 8

  1. Henning R. Swedish co-operative CCU study [PhD thesis, Gothenburg University]. Gothenburg, Sweden, 1975.
  2. Beta-blocker Heart Attack Trial Research Group. A randomised trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982;287:1707-14.
  3. Barbash GL White HD, Modan M, Van de Wcrf F. Significancc of diabetcs mellitus in patients with acute myocardial infarction receiving thrombolytic therapy. J Am Coil Cardiol 1993;22:707-13.
  4. Deacon S, Karunanayake A. Barnett D. Acebutolol, atcnolol and proprano- Iol and metabolic responses to acute hypoglycaemia in diabetes. Br Med J 1977;2:1255-7.
  5. Lager I. Smith U, Blohme G. Effect of cardioselective and nonselective ¢3-blockade on the hypoglycemic response in insulin dependent diabetes. Lancet 1979;1:458-62.
  6. Abramson E, Arky R, Woeber K. Effects of propranolol on the hormonal and the metabolic responses to hypoglycemia. Lancet 1966;2:1386-90.
  7. Corrall R, Frier B, Davidson N, French E. Hormonal and substrate responses during recovery, from hypoglycemia during/31-selective and non- selective beta-adrenergic blockade. Eur J Clin Invest 1981;11:279-83.
  8. Taylor S, Saxton C, Majid P, Dykes J, Ghosh P, Stoker J. Insulin secretion ti~llowing myocardial infarction. Lancet 1969; 1:1373-8.

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Authors
Malmberg, K., Rydén, L., Efendic, S., Herlitz, J., Nicol, P., Waldenstrom, A., Wedel, H., & Welin, L.
Affiliations
Karolinska University Hospital (SE)
Corresponding author
Malmberg, Klas
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1995-07
Volume
26
Issue
1
Pages
57-65
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/0735-1097(95)00126-k
OpenAlex
W2027702390
Cited by
1,560
References
79
Citations by year
2026: 6 · 2025: 15 · 2024: 21 · 2023: 14 · 2022: 21 · 2021: 22 · 2020: 19 · 2019: 25 · 2018: 31 · 2017: 27 · 2016: 28 · 2015: 44 · 2014: 56 · 2013: 62 · 2012: 58
FWCI
16.06
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
glucose-insulin infusion, subcutaneous insulin therapy, acute myocardial infarction, diabetes mellitus, mortality, long-term prognosis, glycemic control, cardiovascular risk profile
MeSH terms
Aged, Diabetes Mellitus, Female, Glucose, Humans, Infusions, Intravenous, Injections, Subcutaneous, Insulin, Male, Myocardial Infarction, Survival Analysis, Hospital Mortality, Diabetes Complications

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