DIGAMI TRIAL PDF
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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J Biol Chem Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents: N Engl J Med D espite many advances in modern medicine, diabetes mellitus continues to be associated with increased morbidity and mortality.
Overall, patients had a mortality of This is consistent with other studies that found early aggressive management may protect patients from diabetic complications. Glucose does not require oxygen when metabolized glycolysisbut this process, as described above, is impaired by the hormonal changes that take place during MI. This impairment may potentiate ischemic heart disease by facilitating coronary artery occlusion and reocclusion. J Am Coll Cardiol Patients who were randomized to the control group were managed according to standard coronary care practice without insulin-glucose infusion.
The leading cause of death in people with diabetes continues to be myocardial infarction MI. The researchers acknowledged this and emphasized that it was the comprehensive care, including insulin and frequent physician visits both acutely and chronically, that might have benefited these patients most.
High cardiac risk was determined by two or more of the following: Health economic benefits and quality of life during improved glycemic control in patients with diabetes mellitus: There is also a possibility that in the course of implementing prolonged intensive insulin therapy, patients had increased follow-up appointments and continuing care visits with their outpatient physicians.
Metabolism 41 Suppl 1: 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.
Mortality and morbidity during five year follow-up of diabetics with myocardial infarction.
Insulin infusion in diabetic patients with acute myocardial infarction. There are indications in experimental settings that propranolol may shift myocardial metabolism from free fatty acid utilization to glucose utilization. Br Med J One such dysfunction is the increased platelet aggregation, which can be reduced with insulin administration. These benefits of intensive treatment were greater in the primary prevention group, whose subjects had no symptoms at baseline.
Some credit the overall improvement to widespread use of medications, such as beta-blockers, aspirin, and thrombolytics. Decreased insulin sensitivity causes impaired glucose utilization and increased free fatty acid turnover in cardiac muscle.
Though the DIGAMI study showed decreased mortality in diabetic patients 1 year after MI, the modest sample size and lack of positive findings in other endpoints make this finding less robust. People with diabetes who suffer an acute myocardial infarction MI are at markedly increased risk of future cardiovascular morbidity and mortality.
Eur Heart J 9: All patients in the study were classified into four pre-stratified groups according to their previous anti-diabetic management and initial cardiac risk classification.
Conclusion Diabetes continues to adversely affect the prognosis in individuals presenting with MI. Effects of insulin treatment on cause specific one-year mortality and morbidity in diabetic patients with acute myocardial infarctions.
Morbidity and mortality were assessed in the acute, sub-acute, and chronic phases. Rate limiting step and effects of insulin and anoxia in heart muscle from diabetic rats.
Kevin Mineo, MD, is is an internal medicine intern. Amsterdam, Elsevier,p.
A final point to emphasize in reviewing the DIGAMI results is the significant mortality reduction noted in patients who were never previously on insulin and who had low cardiac risk factors. Randomized trial of diggami streptokinase, oral aspirin, both or neither among 17, cases of suspected acute myocardial infarction: Though unavoidable, this bias should be taken into consideration before making insulin therapy the standard of care.
Regulation of djgami uptake in muscle. The Diabetes Control and Complications Trial DCCT revealed that intensive insulin therapy delayed the onset and slowed the progression of microangiopathies nephropathy, neuropathy, and retinopathy.
Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction: Metabolism of free fatty acids, glucose, and catacholamines in acute myocardial infarction: The purpose of the DIGAMI study was to evaluate whether diggami initial insulin therapy continued for 3 months would improve these patients’ morbidity and mortality following an acute MI.
Characteristics such as compliance and willingness triall affect a patient’s success in following intensive insulin therapy for any period of time.
DIGAMI-2 TRIAL –
Idgami place the DIGAMI results in perspective, it is important digaml note the decrease in overall mortality in diabetic patients with MI in all treatment groups. In this group, insulin was given in both the acute setting insulin-glucose infusion as well as throughout the year following the MI subcutaneous insulin. Postgrad Med J 52 Suppl 4: Intensive insulin therapy included an insulin-glucose infusion during the initial 24 hours of hospitalization, followed by subcutaneous insulin dibami times daily for a minimum of 3 months.
Subcutaneous insulin was used only if determined to be necessary by a CCU physician, particularly if the patient was on insulin before admission. The pre-stratified risk groups were 1 no previous insulin; low cardiac risk, 2 previous insulin; low cardiac risk, 3 no previous insulin; high cardiac risk, and 4 previous insulin; high cardiac risk.
Though insulin may help reduce mortality in theory, a treatment plan that patients are willing and able to perform may achieve more long-term success.