Author + information
- Received October 24, 1994
- Revision received January 12, 1995
- Accepted February 27, 1995
- Published online July 1, 1995.
- Klas Malmberg, MD*,
- Lars Rydén, MD, FACC,
- Suad Efendic, MD,
- Johan Herlitz, MD,
- Peter Nicol, MD,
- Anders Waldenstrom, MD,
- Hans Wedel, PhD,
- Lennart Welin, MD,
- on Behalf of the DIGAMI Study Group
- ↵*Address for correspondence: Dr. Klas Malmberg, Department of Cardiology, Karolinska Hospital, 171 76 Stockholm. Sweden.
Objectives. We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infarction affected mortality during the subsequent 12 months of follow-up.
Background. Despite significant improvements in acute coronary care, diabetic patients with acute myocardial infarction still have a high mortality rate.
Methods. A total of 620 patients were studied: 306 randomized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for ≥3 months and 314 to conventional therapy.
Results. The two groups were well matched for baseline characteristics. Blood glucose decreased from 15.4 ± 4.1 to 9.6 ± 3.3 mmol/liter (mean ± SD) in the infusion group during the 1st 24 h, and from 15.7 ± 4.2 to 11.7 ± 4.1 among control patients (p < 0.0001). After 1 year 57 subjects (18.6%) in the infusion group and 82 (26.1%) in the control group had died (relative mortality reduction 29%, p = 0.027). The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment (3-month mortality rate 6.5% in the infusion group vs. 13.5% in the control group [relative reduction 52%, p = 0.046]; 1-year mortality rate 8.6% in the infusion group vs. 18.0% in the control group [relative reduction 52%, p = 0.020]).
Conclusions. Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infarction.
This study was supported by the Swedish Heart and Lung Foundation, Hoechst AG and Karolinska Institutet. Stockholm, Sweden.
- Received October 24, 1994.
- Revision received January 12, 1995.
- Accepted February 27, 1995.
- The American College of Cardiology