Document Detail


Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. DIGAMI Study Group. Diabetes Insulin-Glucose in Acute Myocardial Infarction.
MedLine Citation:
PMID:  8880018     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Diabetic patients with acute myocardial infarction have a poor prognosis, which has been attributed to a higher incidence of congestive heart failure and fatal reinfarction. This study reports on the one-year morbidity and mortality in a randomized study with the aim of testing whether insulin-glucose infusion initiated as soon as possible after onset of myocardial infarction and followed by long-term subcutaneous insulin treatment may have a beneficial effect on outcome in diabetic patients. In all, 306 patients were recruited to the insulin-treated group, while 314 patients served as controls. The overall mortality after one year was 19% in the insulin group compared to 26% among controls (P < 0.05). The treatment effect was most pronounced in patients without prior insulin medication and at low cardiovascular risk. In this stratum the in-hospital mortality was reduced by 58% (P < 0.05) and the one-year mortality by 52% (P < 0.02). The most frequent cause of death in all patients was congestive heart failure (66%), but cardiovascular mortality (congestive heart failure, fatal reinfarction, sudden death and stroke) tended to be decreased in insulin-treated patients. However, this difference did not reach the level of statistical significance. The number of reinfarctions was 53 (28% fatal) in the insulin group compared to 55 (45% fatal) in the control group. The two groups did not differ as regards need for hospital care or coronary revascularization during the year of follow-up. In summary, left ventricular failure and fatal reinfarctions contribute to increased mortality in diabetic patients following acute myocardial infarction. Intensive insulin treatment lowered this mortality during one year of follow-up.
Authors:
K Malmberg; L Rydén; A Hamsten; J Herlitz; A Waldenström; H Wedel
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European heart journal     Volume:  17     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1996 Sep 
Date Detail:
Created Date:  1997-01-30     Completed Date:  1997-01-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1337-44     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Karolinska Sjukhuset, Stockholm, Sweden.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Diabetes Mellitus, Type 1 / complications*,  drug therapy*,  physiopathology
Female
Humans
Infusions, Intravenous
Insulin / administration & dosage,  therapeutic use*
Male
Middle Aged
Morbidity
Myocardial Infarction / complications,  drug therapy*,  epidemiology*
Prognosis
Prospective Studies
Survival Rate
Sweden
Chemical
Reg. No./Substance:
11061-68-0/Insulin
Comments/Corrections
Comment In:
Eur Heart J. 1996 Sep;17(9):1298-301   [PMID:  8880010 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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