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Cited by 1,286Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Treatment and ManagementAcute Myocardial Infarction Research

Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus

Open access
Malmberg, Klas·1997·BMJ
DOI 10.1136/bmj.314.7093.1512PMC PMC2126756
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Abstract

Objectives: To test the hypothesis that intensive metabolic treatment with insulin-glucose infusion followed by multidose insulin treatment in patients with diabetes mellitus and acute myocardial infarction improves the prognosis. Design: Patients with diabetes mellitus and acute myocardial infarction were randomly allocated standard treatment plus insulin-glucose infusion for at least 24 hours followed by multidose insulin treatment or standard treatment (controls). Subjects: 620 patients were recruited, of whom 306 received intensive insulin treatment and 314 served as controls. Main outcome measure: Long term all cause mortality. Results: The mean (range) follow up was 3.4 (1.6-5.6) years. There were 102 (33%) deaths in the treatment group compared with 138 (44%) deaths in the control group (relative risk (95% confidence interval) 0.72 (0.55 to 0.92); P=0.011).The effect was most pronounced among the predefined group that included 272 patients without previous insulin treatment and at a low cardiovascular risk (0.49 (0.30 to 0.80); P=0.004). Conclusion: Insulin-glucose infusion followed by intensive subcutaneous insulin in diabetic patients with acute myocardial infarction improves long term survival, and the effect seen at one year continues for at least 3.5 years, with an absolute reduction in mortality of 11%. This means that one life was saved for nine treated patients. The effect was most apparent in patients who had not previously received insulin treatment and who were at a low cardiovascular risk. Key messages: Diabetes mellitus is common among patients with acute myocardial infarction Diabetic patients with myocardial infarction have a poor short and long term prognosis Poor metabolic control is common among diabetic patients with myocardial infarction Improved metabolic control by means of acute insulin-glucose infusion followed by long term intensive insulin treatment improves long term prognosis among these patients

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  • Trials that specifically target postprandial glucose appear more effective and support the idea that postprandial hyperglycaemia is a key contributor to diabetes complications.

    “trials specifically targeting postprandial glucose appear to have been more effective and add further support to the hypothesis that post-prandial hyperglycaemia is a key contributor to diabetes complications [25,26]”

    From Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus (2006) · cites this paper as [25]

  • 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 [319]

  • 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 [319]

  • 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 [319]

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Authors
Malmberg, K.
Affiliations
Karolinska University Hospital (SE)
Corresponding author
Malmberg, Klas
Venue
BMJ
Publisher
BMJ
Published
1997-05-24
Volume
314
Issue
7093
Pages
1512
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.314.7093.1512
PMC
PMC2126756
OpenAlex
W1840840071
Cited by
1,286
References
90
Citations by year
2026: 6 · 2025: 8 · 2024: 10 · 2023: 10 · 2022: 10 · 2021: 16 · 2020: 17 · 2019: 10 · 2018: 15 · 2017: 17 · 2016: 10 · 2015: 36 · 2014: 38 · 2013: 51 · 2012: 39
FWCI
24.92
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Hjärt-Lungfonden
  • Novo Nordisk
  • Rådet for Udviklingsforskning
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 Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
intensive insulin therapy, acute myocardial infarction, diabetes mellitus, glucose-insulin infusion, long-term survival, all-cause mortality, metabolic control, cardiovascular risk
MeSH terms
Aged, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Insulin, Male, Myocardial Infarction, Prospective Studies, Thrombolytic Therapy, Survival Rate, Survival Analysis, Treatment Outcome

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