Insulin infusion in diabetic patients with acute myocardial infarctionBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7074.145 (Published 11 January 1997) Cite this as: BMJ 1997;314:145
Effective components of care and patients who might benefit must be determined
- B Miles Fisher, Consultant physiciana
- a Royal Alexandra Hospital, Paisley PA2 9PN
- b Centre for Diabetes and Cardiovascular Risk, University College London Medical School and Royal Free Hospital School of Medicine, Whittington Hospital, London N19 3UA
- c Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London WC1E 7HT
Editor–Gail Davey and Paul McKeigue suggest that insulin infusion in patients with myocardial infarction is effective in those with known diabetes but may also benefit those with glucose intolerance.1 This is not supported by a detailed analysis of a randomised trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (the DIGAMI study), to which the editorial refers.2 In that study 1240 patients were randomised, and half were excluded because of inability or unwillingness to receive the intervention, which included a short term intravenous infusion followed by a multidose subcutaneous insulin regimen for at least three months.
Only patients at low risk who had not previously received insulin treatment benefited significantly, but whether all of these people had diabetes is uncertain as the study's definition of diabetes was either a prior diagnosis of diabetes or a blood glucose concentration of ≥11 mmol/l on admission (these latter patients were referred to as “previously unknown” patients in the study). Other studies have shown that such a definition will include patients with true previously undiagnosed diabetes (persisting hyperglycaemia, high haemoglobin A1 concentration), patients with diabetes precipitated by the stress of infarction (persisting hyperglycaemia, normal haemoglobin A1), and patients with …