14 May Post Heart Attack: Insulin Based Diabetes Control and Improved Longevity

MedicalResearch.com Interview with:
Viveca Ritsinger MD
Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm
Unit for Research and Development Kronoberg County Council, Växjö, Sweden

MedicalResearch: What are the main findings of the study?

Dr. Ritsinger: This is a long-term follow-up of the Swedish DIGAMI 1 study where patients with acute myocardial infarction and diabetes were randomized to either intensified insulin-based glycaemic control or to standard glucose lowering treatment. Patients and controls were followed for mortality for over 20 years and 90% of the patients died during follow up.

Survival improved during a period of about 8 years. Intensified insulin-based glycaemic control increased survival time by an average of 2.3 years.

MedicalResearch:Were any of the findings unexpected?

Dr. Ritsinger: Our findings that intensified insulin-based glycaemic control increased longevity by as much as almost 50% and that this effect was apparent for as long as at least 8 years were unexpected and gratifying. Also, we were surprised that as much as 10% of the patients were still alive.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Ritsinger: Our findings strengthens the assumption that, if instituted early after an acute myocardial infarction, intensified glycaemic control might indeed have a beneficial effect on mortality in patients with pronounced dysglycaemia. Even if glycaemic control might have been of a proportionately greater importance at the start of the study, as secondary prevention was less developed 20 years ago, it is important not to neglect the significance of glycaemic control.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Ritsinger: There is a need for future studies with extended follow-up time to further clarify the value of tight glycaemic control in prevention of macrovascular complications and improving longevity in patients in a modern setting.

Citation;

Intensified insulin-based glycaemic control after myocardial infarction: mortality during 20 year follow-up of the randomised Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) trial
The Lancet Diabetes & Endocrinology, Early Online Publication, 13 May 2014

doi:10.1016/S2213-8587(14)70088-9

Last Updated on November 10, 2014 by Marie Benz MD FAAD