Insulin infusion in diabetic patients with acute myocardial infarction

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7058.639 (Published 14 September 1996) Cite this as: BMJ 1996;313:639
  1. Gail Davey, Clinical research fellow,
  2. Paul Mckeigue, Senior lecturer
  1. Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London WC1E 7HT

    Effective in diabetes, but patients with glucose intolerance may also benefit

    Despite the improvements brought about by thrombolysis, β blockade, and treatment with angiotensin converting enzyme inhibitors, the mortality in diabetic patients admitted to hospital for acute myocardial infarction remains up to twice that in non-diabetic patients matched for age and sex.1 This increased mortality is apparent both during hospital stay and at longer term follow up in a range of populations, including white Americans,2 Mexican-Americans,3 and people from the Asian subcontinent.4

    The excess mortality is shared by those with diabetes already diagnosed and those with previously undiagnosed diabetes.3 5 The higher mortality of diabetic patients compared with non-diabetic patients is not explained by differences in the extent or severity of coronary artery disease or by differences in infarct size.6 7 8 In patients with longstanding diabetes, complications such as microvascular disease and autonomic neuropathy could predispose to poorer outcome. A more specific reason for poor outcome is the high incidence of cardiac failure in diabetic patients with myocardial infarction, which is also not explained by differences …

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