Myocardial infarction: insulin-glucose decreased death.

Clinical bottom line (level 1b)

Patients with acute myocardial infarction and high admission blood sugars who were given an insulin-glucose infusion were less likely to die than those given standard treatment alone (NNT = 14 at 12 months) .

Malmberg and for the DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group: British Medical Journal 1997; 314: 1512-1515

Expires December 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: 19 hospitals, Sweden

620 patients (aged mean 68 years, 63% male) acute myocardial infarction within preceding 24 hours, combined with previously known diabetes mellitus and a blood glucose concentration >11 mmol/l or a similar blood concentration without known diabetes mellitus

Excluded if

poor health
not within hospital catchment area
enrolled in other studies
previously participated in DIGAMI

Note:

Patients were stratified according to risk (low to high) and previous insulin treatment or not. High risk was defined as having two or more of the following:
- older than 70 years
- previous MI
- history of congestive heart failure
- current treatment with digitalis

Control Group: (n = 314, 314 analysed): standard treatment
Experimental Group: (n = 306, 306 analysed): standard treatment plus insulin-glucose infusion according to predefined protocol for at least 24 hours. Followed by subcutaneous insulin four times daily for at least three months

100% followed for 12 months

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
mortality	12 months	82 (26.1%)	58 (19.0%)	27% (2% to 46%)	7.16% (0.61% to 13.7%)	14 (7 to 160)

Citation

Malmberg K, and for the DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group : Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. British Medical Journal 1997; 314: 1512-1515

Contributor: Clare Wotton and Bob Phillips, December 2000
Reviewer:

_{Clinical Question.}

_Patient	_{acute MI and diabetes mellitus}
_{Intervention or Exposure}	_{intensive insulin}
_Comparison	_{standard treatment}
_Outcome	_mortality