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
|Published (Last):||18 January 2009|
|PDF File Size:||2.28 Mb|
|ePub File Size:||11.31 Mb|
|Price:||Free* [*Free Regsitration Required]|
This makes determining which intervention was responsible for the decrease in mortality impossible: In addition to the diabetes treatment, all patients received thrombolytic therapy streptokinasebeta-blockers, aspirin, heparin, nitroglycerin, percutaneous transluminal coronary angioplasty PTCAand coronary artery bypass graft CABG surgery acutely and chronically as deemed appropriate by their physicians.
Summary diami Results Group characteristics The control group and the infusion group had similar demographics and pre-hospitalization characteristics. Eur Heart J D espite many advances in modern medicine, diabetes mellitus continues to be associated with increased frial and mortality.
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.
This advantage likely cannot be accounted for by the insulin-glucose infusion protocol alone. Thus, regardless of the treatment protocol received, the in-hospital courses trual similar.
Conclusion Diabetes continues to adversely affect the prognosis in individuals presenting with MI. Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents: High cardiac risk was determined by two or more dihami the following: 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.
Am J Cardiol Feasibility of insulin glucose infusion in diabetic patients with acute myocardial infarction. One such dysfunction is the increased platelet aggregation, which can be reduced with insulin administration.
Patients who were randomized to the control group were managed according to standard coronary care practice without insulin-glucose infusion. People with diabetes are more sensitive to catacholamine stimulation, and thus they have a dramatic increase in plasma tria fatty acids and a decrease in glucose utilization.
Diabetes may be associated with severe coronary artery disease, systolic left ventricular dysfunction, autonomic neuropathy, and larger infarct size. Characteristics such as compliance and willingness may affect a patient’s success in following intensive insulin therapy for any period of time. The higher death and complication rates in these diabetic patients appear to be multifactorial. Prospective randomized study of intensive insulin treatment of long-term survival after acute myocardial infarction in patients with diabetes mellitus.
Propranalol and experimental myocardial infarction: Myocardial infarction in patients with diabetes mellitus. Metabolism 41 Suppl 1: Mortality prediction in diabetic patients with myocardial infarction: Though unavoidable, this bias should be taken into consideration before making insulin therapy the standard of care.
Though other studies have evaluated the relationship between improved diabetic control and post-MI morbidity and mortality, the DIGAMI study is the first to show such a large reduction in mortality for diabetic patients with MIs at 1 year.
DIGAMI-2 TRIAL –
The benefits of beta-blockade, specifically in diabetic patients, digaji multifaceted in nature. When viewed with other browsers, some characters or attributes may not be rendered correctly. 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.
Relation between serum free fatty acids and arrhythmias and death after acute myocardial infarctions. In Dugami People with diabetes who suffer an acute myocardial infarction MI are at markedly increased risk of future cardiovascular morbidity and mortality.
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. This is in accord with the DCCT, which recommended treating diabetic patients aggressively early in their disease process to provide the greatest benefit and possibly prevent long-term complications.
Metabolism of free fatty acids, glucose, and catacholamines in acute myocardial infarction: Instead, it showed a decreased mortality in diabetic patients admitted with MIs when given an intensive insulin regimen extending from admission up to 1 year. These benefits of intensive treatment were greater in the primary prevention group, whose subjects had no symptoms at baseline.
Although improvements have been made in the treatment of cardiac disease, diabetic patients with acute MI continue to have a poor prognosis.
Overall, patients had a mortality of Decreased insulin sensitivity causes impaired glucose utilization and increased free fatty acid turnover in cardiac muscle. Mortality and morbidity during five year follow-up of diabetics with myocardial infarction. Other cardiac medications now widely used that may have had an effect on overall diabetic MI mortality are aspirin and thrombolytics. Effects of insulin treatment on cause specific one-year mortality and morbidity in diabetic patients with acute myocardial infarctions.