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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Mortality between groups 1 Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus.
Intensive treatment of coronary artery disease in diabetic patients in clinical pactice: 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.
The use of evidence-based treatment was extensive in all groups. Patient recruitment started in January and ended in May Citing articles via Web of Science Hospital outcome of acute myocardial infarction in patients with and without diabetes mellitus. Can we trust observational data for clinical decision-making?
This caused the patients in group 3 to be somewhat less sick than those in groups 2 and 3. Blood glucose was significantly reduced after 24 h in all groups, more in groups 1 and 2 9.
The corresponding proportion in group 3 was In an epidemiological analysis, background patient characteristics were entered together with updated values for HbA1c and fasting blood glucose as recorded during the time of follow-up in a Cox time-dependent analysis. The need for resources for clinical research: The Steering Committee decided to stop patient recruitment on 21 Maywith the final follow-up scheduled for 15 December 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.
DIGAMI 2 trial post hoc analysis: Lessons in overinterpretation
The average increase in body weight was 4. The most likely reasons diyami this discrepancy are a better-than-expected blood glucose control in groups 2 and 3 in DIGAMI 2 and a less-than-ideal adherence to the use of insulin. Receive exclusive offers and updates from Oxford Academic.
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 seems to be an important part of their management. N Engl J Med. It is therefore not surprising divami long-term glucose control did not differ significantly among the three groups. After 2 years of follow-up, the Kaplan—Meier estimated mortality was Long-term prognosis of diabetic patients with myocardial infarction: Skeie; study nurses, O.
Sample size was based on the 2 year mortality of patients with type 2 diabetes in the control group of the first DIGAMI trial.
The most likely explanation is unfavourable patient allocation in this particular respect, not covered for by our attempt to cause a balanced randomization. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction DIGAMI 2: Slow response to loss of glycemic control in type 2 diabetes mellitus.
None of them aimed for glucose control as a primary target. This resulted in a better glucose control during the hospital period in these two groups than among those in group 3. Metabolic modulation of acute myocardial infarction. Treatment of coronary heart disease in patients with diabetes. 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.
Close mobile search navigation Article navigation. The Steering Committee repeatedly emphasized the importance of a strict adherence to the set targets for glucose control in study group 1.
DIGAMI 2 trial post hoc analysis: Lessons in overinterpretation | MD Magazine
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. I agree to the terms and conditions. With regard to the open study design, the protocol stated that the use of concomitant treatment should be as uniform as possible and according to evidence-based international guidelines for acute myocardial infarction.
This assumption is supported digamk 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. Patients with diabetes have a two-fold increase in hospital mortality when compared with those without diabetes. Thus, the interpretation must be that there is no evidence to support a beneficial effect digaji insulin if sufficient amounts are not given to achieve a difference in glucose levels.
Outpatient visits to the responsible physician were scheduled after 3, 6, 9, and 12 months and thereafter every sixth month.