Intense Insulin Therapy Does Not Improve Outcome After MI

Mortality also did not significantly differ among the three treatment groups. Intense metabolic control using insulin does not improve mortality and morbidity in type 2 diabetic patients after acute myocardial infarction, according to the results of a multicenter European study.

Dr. Lars Ryden from the Karolinska Institute, Stockholm noted that, Insulin does not seem to be the only solution, but tight glucose control by any means is very important," He advises clinicians to "use all available tools to keep blood glucose…down."
Dr. Ryden and colleagues in the Diabetes and Insulin-Glucose Infusion in Acute MI 2 (DIGAMI 2) study compared three glucose management strategies in more than 1200 diabetic patients after suspected acute myocardial infarction.

These included acute insulin-glucose infusion followed by long-term insulin-based treatment; acute insulin-glucose infusion followed by standard glucose control; and routine management according to local practice.

Although blood glucose levels were lower with the first two strategies after the first 24 hours, the authors report, glucose control over time (blood glucose and glycosylated hemoglobin levels) did not differ among the three treatment approaches.

Mortality also did not significantly differ among the three treatment groups. Secondary events (stroke, myocardial reinfarction, etc.) tended to be higher in the most intensive treatment program, but the differences did not reach statistical significance.
Although the three different treatment strategies had similar effects on mortality, "hyperglycemia remained one of the most important prognostic predictors," the investigators note.

"Future development of tools that will allow frequent and precise (non-invasive) measurement of blood glucose levels and, eventually, of an automated system for insulin-titrated tight blood glucose control will be of utmost importance."
Eur Heart J 2005;26:639-641,650-661.

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FACT:
In a recent study from 474 general practitioners and 1,137 patients with newly diagnosed type 2 diabetes. The results imply that GPs react reasonably well upon finding symptoms and signs associated with hyperglycemia. In contrast, very few GPs tested patients for diabetes upon finding elevated cardiovascular risk factors and complications. The authors suggested that screening for diabetes among patients with cardiovascular disease, hypertension, or dyslipidemia should have a more central role in early diagnosis of type 2 diabetes. Diabetologia,48 (210-214): Drivsholm T, de Fine Olivarius N, Nielsen A, Siersma V Symptoms, signs and complications in newly diagnosed type 2 diabetic patients, and their relationship to glycemia, blood pressure and weight

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