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(Circulation. 1999;99:2626-2632.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Glycometabolic State at Admission: Important Risk Marker of Mortality in Conventionally Treated Patients With Diabetes Mellitus and Acute Myocardial Infarction
Long-Term Results From the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Study
From the Department of Cardiology, Karolinska Hospital (K.M., A.N., L.R.), Stockholm, and Nordic School for Public Health (H.W.), Göteborg, Sweden.
Correspondence to Lars Rydén, MD, Department of Cardiology, Karolinska Hospital, S-171 76 Stockholm, Sweden.
Background—The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study addressed prognostic factors and the effects of concomitant treatment and glycometabolic control in diabetic patients with myocardial infarction (AMI).
Methods and Results—Of 620 diabetic patients with AMI, 306 were
randomly assigned to a 
24-hour insulin-glucose infusion
followed by multidose subcutaneous insulin. Three hundred fourteen
patients were randomized as controls, receiving routine antidiabetic
therapy. Thrombolysis and ß-blockers were administered
when possible. Univariate and multivariate
statistical analyses were applied to study predictors of
long-term mortality. During an average follow-up of 3.4 years (range,
1.6 to 5.6 years), 102 patients (33%) in the intensive insulin group
and 138 (44%) in the control group died (P=0.011). Old
age, previous heart failure, diabetes duration, admission blood
glucose, and admission Hb AIc were independent predictors
of mortality in the total cohort, whereas previous AMI, hypertension,
smoking, or female sex did not add independent predictive value.
Metabolic control, mirrored by blood glucose and Hb
AIc, improved significantly more in patients on intensive
insulin treatment than in the control group. ß-Blockers improved
survival in control subjects, whereas thrombolysis was
most efficient in the intensive insulin group.
Conclusions—Mortality in diabetic patients with AMI is predicted by age, previous heart failure, and severity of the glycometabolic state at admission but not by conventional risk factors or sex. Intensive insulin treatment reduced long-term mortality despite high admission blood glucose and Hb AIc.
Key Words: myocardial infarction • diabetes mellitus • mortality • morbidity • glucose • insulin
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D. LeRoith Editorial: A Blast from the Past--Insulin Does It Again! J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3103 - 3104. [Full Text] [PDF]
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 K. S Lewis, S. L Kane-Gill, M. B. Bobek, and J. F Dasta Intensive Insulin Therapy for Critically Ill Patients Ann. Pharmacother., July 1, 2004; 38(7): 1243 - 1251. [Abstract] [Full Text] [PDF]
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J. R Timmer, J. P. Ottervanger, K. Thomas, J. C.A Hoorntje, M.-J. de Boer, H. Suryapranata, F. Zijlstra, and on behalf of the Zwolle myocardial infarction stud Long-term, cause-specific mortality after myocardial infarction in diabetes Eur. Heart J., June 1, 2004; 25(11): 926 - 931. [Abstract] [Full Text] [PDF]
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E. Barrett-Connor, E.-G. V. Giardina, A. K. Gitt, U. Gudat, H. O. Steinberg, and D. Tschoepe Women and Heart Disease: The Role of Diabetes and Hyperglycemia Arch Intern Med, May 10, 2004; 164(9): 934 - 942. [Abstract] [Full Text] [PDF]
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I. Stranders, M. Diamant, R. E. van Gelder, H. J. Spruijt, J. W. R. Twisk, R. J. Heine, and F. C. Visser Admission Blood Glucose Level as Risk Indicator of Death After Myocardial Infarction in Patients With and Without Diabetes Mellitus Arch Intern Med, May 10, 2004; 164(9): 982 - 988. [Abstract] [Full Text] [PDF]
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K. B. Campbell and S. S. Braithwaite Hospital Management of Hyperglycemia Clin. Diabetes, April 1, 2004; 22(2): 81 - 88. [Full Text] [PDF]
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G. Spollett Glucose Control in a Hospitalized Person With Diabetes Diabetes Spectr, April 1, 2004; 17(2): 112 - 114. [Full Text] [PDF]
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 S. Mudaliar Intense Management of Diabetes Mellitus: Role of Glucose Control and Antiplatelet Agents J. Clin. Pharmacol., April 1, 2004; 44(4): 414 - 422. [Abstract] [Full Text] [PDF]
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H Laine, J Sundell, P Nuutila, O T Raitakari, M Luotolahti, T Ronnemaa, T Elomaa, P Koskinen, and J Knuuti Insulin induced increase in coronary flow reserve is abolished by dexamethasone in young men with uncomplicated type 1 diabetes Heart, March 1, 2004; 90(3): 270 - 276. [Abstract] [Full Text] [PDF]
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A. Norhammar, K. Malmberg, E. Diderholm, B. Lagerqvist, B. Lindahl, L. Ryden, and L. Wallentin Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization J. Am. Coll. Cardiol., February 18, 2004; 43(4): 585 - 591. [Abstract] [Full Text] [PDF]
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O. Schnell, O. Schafer, S. Kleybrink, W. Doering, E. Standl, and W. Otter Intensification of Therapeutic Approaches Reduces Mortality in Diabetic Patients With Acute Myocardial Infarction: The Munich registry Diabetes Care, February 1, 2004; 27(2): 455 - 460. [Abstract] [Full Text] [PDF]
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P. A. Goldberg, M. D. Siegel, R. S. Sherwin, J. I. Halickman, M. Lee, V. A. Bailey, S. L. Lee, J. D. Dziura, and S. E. Inzucchi Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit Diabetes Care, February 1, 2004; 27(2): 461 - 467. [Abstract] [Full Text] [PDF]
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S. Clement, S. S. Braithwaite, M. F. Magee, A. Ahmann, E. P. Smith, R. G. Schafer, and I. B. Hirsch Management of Diabetes and Hyperglycemia in Hospitals Diabetes Care, February 1, 2004; 27(2): 553 - 591. [Full Text] [PDF]
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 J. Westerbacka, R. Bergholm, M. Tiikkainen, and H. Yki-Jarvinen Glargine and Regular Human Insulin Similarly Acutely Enhance Endothelium-Dependent Vasodilatation in Normal Subjects Arterioscler Thromb Vasc Biol, February 1, 2004; 24(2): 320 - 324. [Abstract] [Full Text]
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J J Meier, B Gallwitz, W E Schmidt, A Mugge, and M A Nauck Is impairment of ischaemic preconditioning by sulfonylurea drugs clinically important? Heart, January 1, 2004; 90(1): 9 - 12. [Abstract] [Full Text] [PDF]
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 B.-L. Johansson, J. Sundell, K. Ekberg, C. Jonsson, M. Seppanen, O. Raitakari, M. Luotolahti, P. Nuutila, J. Wahren, and J. Knuuti C-peptide improves adenosine-induced myocardial vasodilation in type 1 diabetes patients Am J Physiol Endocrinol Metab, January 1, 2004; 286(1): E14 - E19. [Abstract] [Full Text]
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 R. T. Hurst and R. W. Lee Increased Incidence of Coronary Atherosclerosis in Type 2 Diabetes Mellitus: Mechanisms and Management Ann Intern Med, November 18, 2003; 139(10): 824 - 834. [Abstract] [Full Text] [PDF]
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S. J. Finney, C. Zekveld, A. Elia, and T. W. Evans Glucose Control and Mortality in Critically Ill Patients JAMA, October 15, 2003; 290(15): 2041 - 2047. [Abstract] [Full Text] [PDF]
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 R. Dikow and E. Ritz Cardiovascular complications in the diabetic patient with renal disease: an update in 2003 Nephrol. Dial. Transplant., October 1, 2003; 18(10): 1993 - 1998. [Full Text] [PDF]
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A. Tenerz, A. Norhammar, A. Silveira, A. Hamsten, G. Nilsson, L. Ryden, and K. Malmberg Diabetes, Insulin Resistance, and the Metabolic Syndrome in Patients With Acute Myocardial Infarction Without Previously Known Diabetes Diabetes Care, October 1, 2003; 26(10): 2770 - 2776. [Abstract] [Full Text] [PDF]
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P. A. Brady and A. Jovanovic The sulfonylurea controversy: Much ado about nothing or cause for concern? J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1022 - 1025. [Full Text] [PDF]
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I. L Williams, B. Noronha, and A. G Zaman Review: The management of acute myocardial infarction in patients with diabetes mellitus The British Journal of Diabetes & Vascular Disease, September 1, 2003; 3(5): 319 - 324. [Abstract] [PDF]
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