Author(s): Malmberg K, Rydn L, Efendic S, Herlitz J, Nicol P, , Malmberg K, Rydn L, Efendic S, Herlitz J, Nicol P,
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Abstract OBJECTIVES: We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infarction affected mortality during the subsequent 12 months of follow-up. BACKGROUND: Despite significant improvements in acute coronary care, diabetic patients with acute myocardial infarction still have a high mortality rate. METHODS: A total of 620 patients were studied: 306 randomized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for > or = 3 months and 314 to conventional therapy. RESULTS: The two groups were well matched for baseline characteristics. Blood glucose decreased from 15.4 +/- 4.1 to 9.6 +/- 3.3 mmol/liter (mean +/- SD) in the infusion group during the 1st 24 h, and from 15.7 +/- 4.2 to 11.7 +/- 4.1 among control patients (p < 0.0001). After 1 year 57 subjects (18.6\%) in the infusion group and 82 (26.1\%) in the control group had died (relative mortality reduction 29\%, p = 0.027). The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment (3-month mortality rate 6.5\% in the infusion group vs. 13.5\% in the control group [relative reduction 52\%, p = 0.046]; 1-year mortality rate 8.6\% in the infusion group vs. 18.0\% in the control group [relative reduction 52\%, p = 0.020]). CONCLUSIONS: Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infarction.
This article was published in J Am Coll Cardiol
and referenced in Journal of AIDS & Clinical Research