Abstract 3735: Glucose Lowering Therapy in Post Myocardial Infarction Patients with Diabetes - is Insulin Safe? A report from the Euro Heart Survey on Diabetes and the Heart
Insulin-based treatment in patients with diabetes mellitus (DM) after myocardial infarction (MI) has been supported by the first DIGAMI trial but re-discussed after DIGAMI 2 and some registry studies. This report from the Euro Heart Survey on Diabetes and the Heart relates glucose lowering treatment following MI to cardiovascular (CV) prognosis.
Methods 4676 patients were enrolled at 110 centers in 25 countries, of whom 1425 (30%) had known DM. The diagnosis at discharge was Q-wave MI (joint ESC/ACC definition) in 437 (31%) patients. CV events (CVE=death, MI or stroke) were followed during one year.
Results Of the 437 patients with DM and MI 139 (32%) were prescribed insulin and 197 (45%) oral glucose lowering drugs (OGLD). The remaining 101 (23%) patients were on both medications or data was missing. Baseline characteristics for patients on insulin or OGLD did not differ, except for a higher proportion of smokers in the latter group (9 vs. 12%; p=0.041). There was no difference regarding use of evidence-based medications, echocardiograpic left ventricular ejection fraction or fasting plasma glucose. Patients on insulin were more often treated with PCI (43 vs. 28%; p=0.004). Kaplan-Meier survival curves for patients on insulin (empty) or OGLD (full) are shown in the figure⇓. Following adjustment for significant confounders hazard ratios for death (HR 3.53, 95%CI 1.57–7.94; p=0.002) and CVE (HR 1.46, 95%CI 0.86–2.46; p=0.150) were higher in patients on insulin than in those on OGLD.
Conclusion Insulin treatment in DM patients following MI seems not to be the best glucose lowering option when other modalities are still available.