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Intensive Insulin Therapy Prolongs Life in Post-Acute Myocardial Infarction Diabetes Patients

Intensive insulin treatment extended life by more than two years after acute myocardial infarction (AMI) in patients with diabetes compared with standard treatment….

Researchers from the Karolinska Institute followed 620 patients with type 2 diabetes, beginning in 1990. Patients who were admitted to hospital with a suspected heart attack received an insulin-glucose infusion for at least 24 hours, followed by insulin injection four times a day for at least 3 months or standard glucose-lowering treatment, which only rarely involved insulin, for 1 year.
During the 20-year study period, most of the patients died of some cause. Results indicate, however, that those who received intensified insulin treatment during the trial survived a median of 2.3 years longer compared with those who received standard treatment.
The effect was apparent for at least 8 years after randomization before leveling off, according to the study. The greatest benefit from the intensive insulin treatment was for patients who appeared to be at low cardiovascular risk, were less than 70 years old, had no history of heart attack or congestive heart failure, and had not previously had insulin therapy.
The authors note that, although the results clearly show a benefit of intensive insulin treatment after a heart attack in patients with type 2 diabetes, the effect on survival is probably greater than if the trial was started today. The reason, they explain, is because of advances in conventional treatment of patients with type 2 diabetes and cardiovascular complications, including statins and angiotensin-converting-enzyme inhibitors.
Practice Pearls:

  • Those who received intensified insulin treatment during the trial survived a median of 2.3 years longer
  • The results show a benefit of intensive insulin treatment after a heart attack in patients with type 2 diabetes

The report, based on long-term follow-up of the DIGAMI 1 trial — a landmark study of type 2 diabetes in Sweden — was published recently in The Lancet Diabetes &Endocrinology, May 2014