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| Presentation |
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"The DIGAMI studies: Implications for practice"Prof. Timothy Davis (biography)
English - 2004-09-23 - 26 minutes
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 | (21 slides) |
Summary :
In this presentation Prof. Davis reviews the results of the DIGAMI-1 (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction-1) study and preliminary results from the DIGAMI-2 study.
In a systematic review and meta-analysis published by Capes et al., it was found that hyperglycaemia increased mortality in patients with acute myocardial infarction (AMI) (1), and it has also been shown that glucose/insulin/potassium (GIK) infusions reduce inpatient mortality from AMI (2,3).
DIGAMI-1 was a randomised prospective study with an average follow up of 3.4 years. Diabetic patients with suspected AMI and having a blood glucose level over 11 mmol/L were randomised to receive insulin therapy or standard treatment. This study found a decrease in mortality in the insulin-treated patients (4) although it remained uncertain whether the benefit was due to the insulin-glucose infusion in the first 24 hours of admission, or the follow up longer-term subcutaneous insulin therapy.
Preliminary results from the DIGAMI-2 study were presented at the 2004 EASD meeting in Munich. The study was designed to compare acute insulin-glucose infusion followed by long-term subcutaneous insulin therapy versus acute insulin-glucose infusion followed by conventional therapy versus conventional therapy alone, in diabetic patients with suspected AMI. After 2 years of follow up there were no significant differences found in the mortality rates between the 3 groups on intention-to-treat analysis, but rather a trend was observed suggesting better survival in the conventionally treated group.
Prof. Davis concludes his presentation with an interpretation of these results and a discussion of how the DIGAMI studies may impact clinical practice.
Copyright © 2004 E-MedHosting.com Inc.
Learning objectives :
- To review the results of DIGAMI-1 and their implications for management of acute coronary syndromes in diabetes
- To assess the recently presented preliminary results of DIGAMI-2 and their possible impact on the recommendations arising out of DIGAMI-1
Bibliographic references :
1. Capes SE, Hunt D, Malmberg K, Gerstein HC.Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview Lancet. 2000 Mar 4;355(9206):773-8.
2. Farzin Fath-Ordoubadi, BSc, MB BCHIR, MRCP; ; Kevin J. Beatt, PhD, FESC, FACC.Glucose-Insulin-Potassium Therapy for Treatment of Acute Myocardial Infarction Circulation. 1997;96:1152-1156.
3. Rafael Díaz, MD; Ernesto A. Paolasso, MD; Leopoldo S. Piegas, MD; Carlos D. Tajer, MD; Manuel Gil Moreno, MD; Ramón Corvalán, MD; Jesús E. Isea, MD; Graciela Romero, MD.Metabolic Modulation of Acute Myocardial Infarction: The ECLA Glucose-Insulin-Potassium Pilot Trial Circulation. 1998;98:2227-2234.
4. Klas Malmberg, for the DIGAMI (Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus BMJ 1997;314:1512.
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