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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Based on these multifaceted benefits of insulin, a multicenter trial was recently performed in Sweden to evaluate the effects of intravenous insulin and glucose infusions in diabetic patients who were experiencing an acute MI.
Overall, concomitant therapy was similar between both groups of the study. In Diabetes and Heart Disease. Morbidity and mortality were assessed in the acute, sub-acute, and chronic phases. Glucose does not require oxygen when metabolized glycolysisbut this process, as frial above, is impaired by the hormonal changes that take place during MI. Other cardiac medications now widely used that may have had an effect rrial overall triao MI mortality are aspirin and thrombolytics. Conclusion Diabetes continues to adversely affect the prognosis in individuals presenting with MI.
The remaining patients were then randomized to either a control group patients or an insulin infusion group patients. In the past, beta-blockers were not used in diabetic patients for fear of masking and possibly prolonging of hypoglycemic episodes.
Overall, this study was successful in showing the feasibility and potential advantage of aggressive long-term insulin management in diabetic patients with MIs. Kevin Mineo, MD, is is an internal medicine intern. This impairment may potentiate ischemic heart disease by facilitating coronary artery occlusion and reocclusion. Clinical course of myocardial infarction among dugami patients.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. In reviewing this study’s population, patients who were not willing or able to commit to insulin were excluded. The diagnosis of MI was divided into probable or possible using conventional criteria Table 1. Mortality and morbidity during five year follow-up of diabetics with myocardial infarction.
Plasma catecholamines, glucagon, and cortisol increase, resulting in insulin resistance. Br Med J This study did not provide data showing a direct relationship between insulin-glucose infusion and the decreased mortality at 1 year.
This is consistent with other studies that found early aggressive management may protect patients from diabetic complications. Propranalol and experimental myocardial infarction: One such dysfunction is the increased platelet aggregation, which can be reduced with insulin administration.
This makes determining which intervention was responsible for the decrease in mortality impossible: Postgrad Med J 52 Suppl 4: 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.
The authors of the DIGAMI study addressed this possible discrepancy, stating that any increased follow-up should be considered part of comprehensive aggressive diabetic management.
When viewed with other browsers, some characters or attributes may not be rendered correctly. Diabetes may be associated with severe coronary artery disease, systolic left ventricular dysfunction, autonomic neuropathy, and larger infarct size. The purpose of the DIGAMI study was to evaluate whether aggressive initial insulin therapy continued for 3 months would improve these patients’ morbidity and mortality following an acute MI.
Acta Med Scand J Am Coll Cardiol 21 4: Jennifer Cummings, MD, is an internal medicine resident.
DIGAMI-2 TRIAL –
Though the DIGAMI study showed tiral 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. This in itself may have created a bias because the patients studied were required to agree to aggressive insulin therapy for an extended period of time.
Metabolism of free fatty acids, glucose, and catacholamines in acute myocardial infarction: When examining mortality in the pre-stratified risk groups, the greatest mortality reduction is noted for patients who had never been on insulin before and were classified as low cardiac risk. Myocardial infarction in patients with diabetes mellitus. Metabolism 41 Suppl 1: These actions of insulin appear to reduce many of the biochemical obstacles diabetic patients face during and after MI.
Thromboxane A production and platelet aggregability have been shown to be increased in diabetic patients, fostering a hypercoagulable state. It is reasonable to propose that increased anti-platelet and fibrinolytic therapy may have aided in the overall decreased mortality in the diabetic patients tfial cardiac events included in this study.
This supply-demand imbalance creates an energy deficit that leads to myocardial ischemia. The change in mortality during hospitalization and at 3 months post-MI was not significant. Overall, patients had a mortality of 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.
Initial metabolic and hormonal response to acute myocardial infarction: Patients then received insulin-glucose infusions or standard diabetes care according to the study’s protocol Figure 1.