Insulin vs. strict blood glucose control to achieve a survival benefit after AMI?
Why the study?
Does intensive insulin therapy with strict blood glucose control reduce morbidity and mortality in patients with diabetes mellitus and acute myocardial infarction?
Population
Patients with diabetes mellitus and acute myocardial infarction (AMI)
Comparison
Glucose-insulin-potassium infusion for 24 hours… vs GIK infusion for 24 hours followed by standard…
Design
Editorial, Randomized into three groups
Authors
Discussion
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Member takes
Implication
Intensive insulin without achieved targets does not reduce post-MI morbidity; leaves open whether strict glycaemic control improves outcomes.
Structured PICO
Does intensive insulin therapy with strict blood glucose control reduce morbidity and mortality in patients with diabetes mellitus and acute myocardial infarction?
P
Population
Patients with diabetes mellitus and acute myocardial infarction (AMI)
I
Intervention
Glucose-insulin-potassium (GIK) infusion for 24 hours followed by insulin-based long-term glucose control aiming for fasting blood glucose of 5-7 mmol/L
C
Comparator
GIK infusion for 24 hours followed by standard glucose control, or routine management according to local practice
O
Outcome
Morbidity and mortalityhard clinical
The editorial highlights that the failure of DIGAMI 2 to show a survival benefit was due to the inability to achieve target blood glucose levels, suggesting that tight glycemic control rather than insulin administration itself is key to improving outcomes after AMI.
Limitations
- Target fasting blood glucose of 5-7 mmol/L was never reached
- Blood glucose control ended up being identical in all three study groups
- Patient recruitment did not proceed as planned
- Study was stopped early with fewer than half of planned patients included due to limited funding
Cite This Study
Greet Van den Berghe (2005) studied this question.