The relationship between glycaemic variability and cardiovascular complications in patients with acute myocardial infarction and type 2 diabetes: a report from the DIGAMI 2 trial
Abstract
AIMS: Hyperglycaemia during hospitalization for acute myocardial infarction (AMI) is a risk predictor, but attempts to improve the prognosis by insulin-based glucose control have not been consistently successful. Increased glycaemic variability, a potential effect of insulin treatment, has been linked to a worse prognosis in critically ill patients. The present aim was to study the possibility of such a relation in patients with type 2 diabetes (T2DM) and AMI. METHOD AND RESULTS: We studied 578 T2DM patients who had glucose levels measured hourly while receiving an insulin-glucose infusion during the first 48 h of hospitalization for AMI. Three measures of glycaemic variability: root mean square error (RMSE), range, and slope were studied in relation to a composite endpoint of mortality, stroke, and reinfarction and to mortality. In unadjusted analyses, the mean level of glycaemic variability did not differ between patients who died during 12 months of follow-up compared with those who survived. In a Cox regression model adjusting for age and previous congestive heart failure, there was no increased risk for the composite endpoint associated with increased glycaemic variability; RMSE: hazard ratio (HR) 1.09 [95% confidence interval (CI) 0.93-1.27; P = 0.28], range: HR 1.01 (95% CI: 0.98-1.05; P = 0.47), and slope: HR 1.01 (95% CI: 0.99-1.04; P = 0.40). There was furthermore no increased risk in mortality; RMSE HR 1.14 (95% CI: 0.93-1.38; P = 0.21), range HR 1.03 (95% CI: 0.98-1.08; P = 0.28), and slope HR 1.01 (95% CI: 0.98-1.04; P = 0.55). CONCLUSION: The 1-year risk for death, reinfarction, or stroke did not relate to glycaemic variability in T2DM patients with AMI treated with insulin infusion.
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In DIGAMI 2, there was no association between glycemic variability and complications (composite endpoint: RMSE p=0.28, HR 1.09, 0.93-1.27; mortality p=0.21, HR 1.14, 0.93-1.38).
“No association between GV and complications.Composite endpoint: RMSE p=0.28, HR 1.09 (0.93–1.27), mortality p=0.21, HR 1.14 (0.93–1.38).”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [53]
In the DIGAMI 2 study, there was no relationship between glycemic variability and acute cardiovascular complications in 578 patients with type 2 diabetes.
“reported no relationship between GV and acute cardiovascular complications in 578 patients with T2D.53”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [53]
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- Authors
- Mellbin, L. G., Malmberg, K., Rydén, L., Wedel, H., Vestberg, D., & Lind, M.
- Affiliations
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- Nordic School of Public Health (SE)
- University of Gothenburg (SE)
- Corresponding author
- Mellbin, Linda G.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-11-09
- Volume
- 34
- Issue
- 5
- Pages
- 374-379
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2125208805
- Cited by
- 57
- References
- 28
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 6 · 2018: 7 · 2017: 3 · 2016: 5 · 2015: 10 · 2014: 7 · 2013: 1
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- glycemic variability, acute myocardial infarction, type 2 diabetes, insulin infusion, glycemic control, root mean square error, mortality, reinfarction, stroke, cardiovascular complications
- MeSH terms
- Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glucose, Hospitalization, Humans, Hyperglycemia, Hypoglycemic Agents, Infusions, Intravenous, Insulin, Male, Myocardial Infarction, Prognosis, Prospective Studies, Recurrence, Stroke, Diabetic Cardiomyopathies
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