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Intensive insulin treatment after acute myocardial infarction in diabetes mellitus

BMJ 1997; 315 doi: (Published 30 August 1997) Cite this as: BMJ 1997;315:544

Evidence exists from study of non-insulin dependent diabetes in Japan

  1. Rhys Williams, Professor of epidemiology and public healtha
  1. a Nuffield Institute for Health, Leeds LS2 9PL
  2. b Royal Alexander Hospital, Paisley, Renfrewshire PA2 9PN
  3. c Glasgow Royal Infirmary, Glasgow G4 0SF

    Editor—In his editorial prompted by the publication of the DIGAMI (diabetes mellitus, insulin glucose infusion in acute myocardial infarction) trial,1 Malcolm Nattrass states that (in non-insulin dependent diabetes) “evidence [is] still awaited for a relation between diabetic control and microvascular complications.”2 It is true that we all await with interest the results of the United Kingdom prospective diabetes study, but some evidence does already exist. Although it is not directly relevant to Nattrass's editorial, in other contexts I have been surprised that it is rarely discussed and is almost never referenced in publications written by authors working on diabetes outside Asia and Australasia.

    The study to which I refer is the Kumamoto study.3 This randomised 110 patients with non-insulin dependent diabetes (half with existing microvascular complications and half without) into a group treated with multiple injections and a group given normal care. After six years of follow up, both retinopathy and nephropathy were convincingly less common in the group treated with multiple injections—both the primary prevention cohort and the secondary prevention cohort.

    While I do not necessarily advocate this trial as definitive evidence of the same effect as that in the diabetes control and complications trial in non-insulin dependent diabetes, it …

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