The DIGAMI 2 Trial is reviewed and summarized including methods, results and conclusions. The primary and secondary endpoints and inclusion and exclusion . The DIGAMI Trial is reviewed and summarized including methods, results and conclusions. The primary and secondary endpoints are included as well as. Methods and results DIGAMI 2 recruited patients (mean age 68 years; 67% males) with type 2 diabetes and suspected acute myocardial.

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Dogami blood glucose was obtained as soon as possible after hospital admission. The main analysis was performed by means of an un-adjusted Cox proportional hazards model on an intention to treat basis, while the proportional hazards assumption was not assessed.

The median study duration was 2. The study conformed to good clinical practice guidelines and followed the recommendations of the Helsinki Declaration.

DIGAMI 2 was a multicentre, prospective randomized, open trial with blinded evaluation comparing three different management strategies in patients with type 2 diabetes and acute dkgami infarction. The corresponding proportion in group 3 was The study mortality groups combined was An independent committee comprising three experienced cardiologists adjudicated all events blindly and could, as indicated, ask for any type ditami information felt needed to ensure a correct classification of the events and the reasons for mortality.

Intensive treatment of coronary artery disease in diabetic patients in clinical pactice: The reason was slow patient recruitment. Insulin was given as short-acting insulin before meals and intermediate long-acting insulin in the evening.

Experience from the CODE study 18 and registries 19 does indeed support the finding that glucose control often is far from satisfactory albeit slowly improving. The grey area A represents the target levels for blood glucose.

One week following hospital discharge, patients returned to a nurse-based outpatient clinic, in particular focusing on the treatment of diabetes. Rigami alerts New issue alert. Outcome benefit of insulin therapy in the crtitical ill: In contrast, the continued glucose-lowering treatment in group 1 was less effective than prescribed by the protocol.


Deaths were verified with death certificates, hospital records, and explaining letters from the physicians in charge when asked for by the adjudication committee members and autopsy reports when available.

Well-designed and adequately powered studies are needed to determine the effect and role of insulin in acute coronary syndrome patients. Exclusion criteria were inability to cope with insulin treatment or to receive information on the study; residence outside the hospital catchment area; participation in other studies, or previous participation in DIGAMI 2. The average increase in body weight was 4. The need for resources for clinical research: The use of evidence-based treatment was extensive in all groups.

The interpretation of DIGAMI 2 is that for a similar glycaemic control insulin treatment is not superior to the use of other therapeutic options as regards mortality outcome. Needless to say, a selection bias hampers diyami comparisons, but the inclusion criteria in the DIGAMI 2 were wide and without age diyami, whereas the registry does not include people above the age of 80 years.

Fasting blood glucose represents updated values during the time of follow-up. Non-cardiovascular deaths, including malignancies, were adjudicated according the same principles as cardiovascular events. Mortality between diigami 1 Blood glucose was significantly reduced after 24 h in all groups, more in groups 1 and 2 9. The Euro Heart Survey on diabetes and the heart.

Add comment Close comment form dkgami. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction DIGAMI study: Several hormonal mechanisms contribute to a decrease in insulin sensitivity and glucose utilization during acute myocardial ischaemia.

An important message from the DIGAMI 2 trial is that updated HbA1c and blood glucose were significant and independent mortality predictors together with the traditional risk factors age, heart failure, and elevated serum creatinin. Close mobile search navigation Article dlgami. Receive exclusive offers and updates digai Oxford Academic. Latest Most Read Most Cited Transcatheter aortic valve replacement in patients with concomitant mitral stenosis.

This assumption is supported by short-term data from the Munich registry report that intensification of multiple therapeutic strategies, including insulin infusions, resulted in a substantial reduction of in-hospital mortality comparable to the rates in non-diabetic patients.


DIGAMI 2 trial post hoc analysis: Lessons in overinterpretation

View large Download slide. However, there were significantly fewer previous myocardial infarctions and a trend towards less hypertension and heart failure in group 3.

However, an epidemiological analysis confirms that the glucose level is a strong, independent predictor of long-term mortality in this patient category, underlining that glucose control is an important part of their management. The concept of initiating treatment with insulin infusion to rapidly attain a normalized blood glucose has support from the first DIGAMI trial and the study in patients in intensive care by Van den Berghe et al.

DIGAMI 2 trial post hoc analysis: Lessons in overinterpretation | MD Magazine

For Permissions, please e-mail: Citing articles via Web of Science Apart from the initial insulin—glucose infusion given to patients in group 2, the glucose-lowering treatment in groups 2 and 3 was at the discretion of the responsible physician and according to local routines. However, an epidemiological analysis confirms that the glucose level is a strong, independent predictor of long-term mortality in this patient category, underlining that glucose digam seems to be an important part of their management.

Lewis-Barned; study diga,i, L. Moreover, the study could not answer the question of whether the beneficial effects related to the acute insulin—glucose infusion or to the continuous insulin-based metabolic control or both.

In group 1, most of these deaths occurred early, during the first year of follow-up, which is strong evidence against a true relation. The three groups were well balanced in most respects.

The most important message from this investigation of three different treatment strategies for glucose control in patients with type 2 diabetes and acute myocardial infarction is that they were similar with regard to effects on long- or short-term mortality.