The digami study on the use of intravenous insulin infusion atthe time of myocardial infarction mi has stimulated a largenumber of discussion papers on the best treatment of mi in thediabetic patient. In a retrospective study conducted in 865 trauma and 5234 nontrauma patients mortality in both groups 12%, the relation between hyperglycaemia and mortality was stronger in trauma patients than in other surgical icu patients. A userfriendly, pocketsized reference for all physicians faced with endocrine care and challenges in hospitalized patients, this handbook covers the most common issues leading to an inpatient endocrine consult, providing differential diagnoses, a reasonable and practical approach to investigating and managing the condition, and advice for followup. Abstract in patients with diabetes, a complex and controversial relationship exists between intensive glycemic control and cardiovascular cv outcomes. The digami study demonstrated that intensive insulin therapy reduced allcause mortality in ami patients, but the subsequent digami 2 and hi5 studies did not show this effect. Intensive insulin infusion in infarction hi5 study was to determine whether tight glycemic control improves outcomes for hyperglycemic patients with ami. The evidence base included one study where 50% of the study population had an admission glucose lower than the value accepted by the working group to define hyperglycaemia,7 and another in which the mean admission blood glucose was 8. Hyperglycemia at the time of hospital admission predicts increased mortality in patients with acute coronary syndromes acs, including stsegment elevation myocardial infarction stemi 16, revascularization procedures such as thrombolysis or percutaneous coronary intervention pci 710, and other critical illnesses 11. Though other studies have evaluated the relationship between improved diabetic control and postmi 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.
The digami study compared conventional antidiabetic therapy to intensive insulin therapy consisting of acute insulin infusion during the early hours of mi and. Norhammar a, tenerz a, nilsson g, hansten a, efendic s, ryden l, malmberg k. It improves insulin sensitivity and is helpful especially in. Hyperglycaemia and myocardial infarction british journal of. Subsequent studiesdigami2 n 1,253 46 and the hi5 hyperglycemia. The society of thoracic surgeons practice guideline series. Adobe acrobat reader dc software is the free global standard for reliably viewing, printing, and commenting on pdf documents. Prognostic implications of glucoselowering treatment in patients. The digami study underscores the importance of early and aggressive interventions designed to bring glucose levels into the normal range regardless of a patients prior diabetes status. The digami study diabetes mellitus insulinglucose infusion in acute myocardial infarction was initiated to test the hypothesis that rapid improvement of metabolic control in diabetic patients with acute myocardial infarction by means of insulinglucose infusion decreases the high initial mortality. Antihyperglycemic drugs and cardiovascular outcomes in type 2. The diabetes insulinglucose in acute myocardial infarction digami trial demonstrated significant reductions in mortality when an intensive insulin regimen was administered to hyperglycemic patients hospitalized with acute mi. Retrospective data from two large scale studies, eur heart j, 10 1989, pp.
In the first digami study, an insulinbased glucose management. Hyperglycaemia in critically ill patients amsterdam umc vrije. A detailed description of digami including study design, definitions and methods has been given elsewhere. Mortality prediction in diabetic patients with myocardial infarction. There is now evidence to suggest that achieving glycemic control in patients with diabetes decreases perioperative morbidity and. Selfrated health predicts outcome in patients with type 2 diabetes and myocardial infarction. Exclusion criteria were inability to cope with insulin treatment or to receive information on the study.
The digami diabetes mellitus, insulin glucose infusion in. Antihyperglycemic drugs and cardiovascular outcomes in. Within the framework of the clinical trial digami 2 hypoglycaemic episodes blood glucose study attempted to rectify some of the issues that were encountered in digami 2. Glucose control was to be achieved through an insulindextrose infusion with a variable rate of insulin. Digami 2independent baseline predictors for death including updated fasting glucose values. Our results suggest that fasting and postchallenge hyperglycaemia in the early phase of an acute myocardial infarction could be used as early markers of highrisk individuals. The prevalence of diabetes mellitus in patients requiring cardiac surgery is rapidly increasing. Prognostic implications of hypoglycaemic episodes during. Prognostic implications of glucoselowering treatment in. Glucose regulation in acute coronary syndrome the jama network. The digami study is a multicenter randomized controlled trial comparing between blood glucose level digami studies, the goal of the hyperglycemia. Download fulltext pdf download fulltext pdf mannosebinding lectin genotype and phenotype in patients with type 2 diabetes and myocardial infarction. Our findings show that the small bites suture technique is more effective than the traditional large bites technique for prevention of incisional hernia in midline incisions and is not associated with a higher rate of adverse events. Impact of hyperglycemia on longterm outcome in patients with.
Prognostic implications of glucoselowering treatment in patients with acute myocardial infarction and diabetes. The digami study published in 1995 reignited interest in the use of insulin following acute mi. Although the effect of glucose lowering might be less apparent with presently available, more effective lipidlowering and bloodpressurelowering drugs, improved glycaemic control might still be important for longevity. These abnormalities can be detected early in the postinfarction period. Hyperglycemia and adverse outcomes in acute coronary. On the basis of these findings, the diabetes mellitus insulin glucose infusion in acute myocardial infarction digami 1 trial was started. Actually, the digami study has brought too many criticisms, such as the uncertainty whether the gik infusion during ami or the followed longterm insulin treatment caused the favorable longterm outcome, the small simple size, large confident intervals and the potential bias resulted with only the 50% of all eligible patients being randomized. The evidencebased reduction in risk of microvascular disease with glucose lowering has resulted in guidelines worldwide. The trial is expected to generate discussion in the diabetes. Diabetic cardiology practical diabetes pdf libribook.
Like the digami studies, the goal of the hyperglycemia. Competition for study recruitment with commercially funded studies may partially explain the difficulty. Intensive insulin infusion in infarction study n 240, 47 both investigating the effects of intensive insulin therapy in patients with type 2 diabetes and mishowed no significant effects on mortality in patients at 1 year digami. Pdf fasttrack intense metabolic control by means of insulin in. The study conformed to good clinical practice guidelines and followed the recommendations of the helsinki declaration. Randomized trial of insulinglucose infusion followed by. Before randomization, the patients were stratified into 4 groups on the basis of risk. Pdf say no to diabetes download full pdf book download. These patients have higher perioperative morbidity and mortality, significantly reduced longterm survival, and less freedom from recurrent episodes of angina. The diabetes insulinglucose in acute myocardial infarction digami study changed. Randomised trial of insulinglucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction digami study. Intensive insulin infusion in infarction study n 240, 47 both investigating the effects of intensive insulin therapy in patients with type 2 diabetes and mishowed no significant effects on mortality in patients at 1 year digami2 and 6 months hi5. Pdf mannosebinding lectin genotype and phenotype in.
Randomized trial of insulinglucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction digami study. The veterans affairs cooperative studies program vacsp has just initiated a trial of the effect of intensive glucose control on cardiovascular complications in patients with type 2 diabetes. Although the value of glucoselowering agents in preventing microvascular complications associated with diabetes has been established, along with reductions in ischemic coronary events, active treatment in one major glycemiccontrol trial. Among the spectral domain measures, after adjustment for age, sex, baseline hrv measure, history of myocardial infarction, bmi at study exit, physical activity level at study exit, and baseline depression and anger scores, there was a statistically significant difference in. Objective the present study characterizes mannosebinding lectin mbl, an activator of the complement system and thereby important for inflammatory activation, in patients with diabetes and myocardial infarction. Also, the digami population, though modest in size, was larger than had been examined before. Its the only pdf viewer that can open and interact with all types of pdf content, including. It is well established that hyperglycaemia is common in patients admitted to the hospital with acute coronary syndrome acs, and is an an independent risk factor for adverse outcome.
Digami 2 was designed to test whether intense metabolic control by means of insulin was able to reduce mortality following acute myocardial infarction. And now, its connected to the adobe document cloud. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus. In animal studies, infarct size was linearly related to blood glucose concentration during acute. While the digami study was able to demonstrate a decrease in both mortality and mean 24hour blood glucose levels, the digami2 and hi5 studies showed no such significant decrease figure 2 2729. The prevalence of hyperglycaemia in critically ill patients approaches 100%. Diabetic cardiology pdf free pdf epub medical books. Experience from the code study 18 and registries 19 does indeed.
Publications home of jama and the specialty journals of the. Admission hyperglycemia and acute myocardial infarction. The 1 year mortality was reduced by 30% in the intensively treated group. While the digami study was able to demonstrate a decrease in both mortality and mean 24hour blood glucose levels, the digami 2 and hi5 studies showed no such signi. It is important to note, however, that the digami study did identify the benefit of strict glycaemic control in patients with ami. Nice recommendations for the management of hyperglycaemia in. Diabetes mellitus, insulinglucose infusion in acute. Importantly, the varying glucose target levels of these studies make it difficult to compare their results and infer a firm conclusion. Publications home of jama and the specialty journals of. In diabetics who have had an mi, the digami study showed that intravenous insulin for 24 hours and subcutaneous insulin for 3 months improved mortality rates for up to 3 years after. Intense metabolic control by means of insulin in patients with. Admissionhyperglycemia andacutemyocardialinfarction.
Role of tight glycemic control during acute coronary. Effect of insulinglucose infusion on mortality following. To explore if hypoglycaemic episodes during hospitalisation influence the subsequent prognosis in patients with diabetes and acute myocardial infarction. Mortality prediction in diabetic patients with myocardial. Management of hyperglycemia and diabetes in the hospital. Management of acute coronary syndrome in special subgroups. Endocrinologymetabolismdiabetes mellitus medical books free. The relationship between blood glucose and mortality. Briefly, this is a multicentre, randomised, prospective study on the effect on mortality and morbidity of an intravenous infusion of insulinglucose followed by 4dose subcutaneous insulin therapy given to patients with suspected acute.
Intense metabolic control by means of insulin in patients. The power calculation indicated that 3,000 patients would be required, but despite intense efforts at recruitment only 1,253 patients had been randomised after 5 years, and the steering committee stopped the trial. Importantly, the varying glucose target levels of these studies make it di. We studied the 865 patients who survived during 12 months without any change in their glucose. Say no to diabetes available for download and read online in other formats. The nature of the study, a truly investigatorinitiated trial, rendered it a lowbudget trial despite generous research grants. While the digami study was able to demonstrate a decrease in both mortality and mean 24hour blood glucose levels, the digami 2 and hi5 studies showed no such significant decrease figure 2 2729. Why does this approach raise such a serious concern. Effects on allcause mortality and cardiovascular outcomes. In a multivariable epidemiological analysis the digami 2 trial clearly confirmed that blood glucose is a strong and independent predictor of longterm mortality following mi in patients with type 2 diabetes. We searched medline, embase, cochrane central register of controlled trials, chinese biological medicine database, china national knowledge infrastructure, chinese technical periodicals, and wanfang data, up to july 10, 2015, for rcts on insulin and ohas that assessed allcause mortality andor cardiovascular death as primary end points. An increase in updated glucose over the complete study period by. This post hoc analysis from the diabetes mellitus insulinglucose infusion in acute myocardial infarction digami 2 trial reports on extended.
An increase in updated glucose over the complete study period by 3 mmoll caused a mortality increase of 20%. In four highdose gik studies 288 patients, differences in mortality were not statistically significant. Patients assigned to the intensive insulininfusion arm received standard insulin and dextrose. Within the framework of the clinical trial digami 2 hypoglycaemic episodes blood glucose may 12, 2014 intensified insulinbased glycaemic control after acute myocardial infarction in patients with diabetes and hyperglycaemia at admission had a longlasting effect on longevity. Bode, md, face atlanta diabetes associates atlanta, georgia hyperglycemia in hospitalized patients hyperglycemia occurred in 38% of hospitalized patients 26% had known history of diabetes 12% had no history of diabetes newly discovered hyperglycemia was associated with. Concomitant treatment with regard to the open study design, the protocol stated that the use of concomitant treatment should be as uniform as possible and according to evidencebased international.
Overall, this study was successful in showing the feasibility and potential advantage of aggressive longterm insulin management in diabetic patients with mis. The subsequent digami 2 study malmberg et al, 2005 sought to answer queries raised by the original study but was also controversial. The diabetes mellitus, insulin glucose infusion in acute myocardial infarction digami study malmberg et al, 1994. Adobe acrobat reader dc download free pdf viewer for.
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