The DIGAMI 2 Trial is reviewed and summarized including methods, results and conclusions. The primary and secondary endpoints and inclusion and exclusion . The DIGAMI Trial is reviewed and summarized including methods, results and conclusions. The primary and secondary endpoints are included as well as. Methods and results DIGAMI 2 recruited patients (mean age 68 years; 67% males) with type 2 diabetes and suspected acute myocardial.
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By the end of follow-up, HbA1c did not differ significantly among groups approximately 6. Local ethics review boards approved the protocol. Exclusion criteria were inability to cope with insulin treatment or to receive information on the study; residence outside the hospital catchment area; participation in other studies, or previous participation in DIGAMI 2. After an average of 3. One week sigami hospital discharge, patients returned to a nurse-based outpatient clinic, in particular focusing on the treatment of diabetes.
Indeed blood glucose increased in most of these studies during infusion of high concentrations of glucose—insulin—potassium.
The outcome of DIGAMI 2 contrasts with the findings in the first DIGAMI trial, which concluded that an insulin—glucose infusion followed by insulin-based therapeutic regime reduced mortality in diabetic patients with acute myocardial infarction.
The actual 2 year mortality of The DIGAMI 2 trial was planned and conducted to further explore the possible benefits of an insulin-based management of diabetic patients with myocardial infarction.
In their paper, the ISIS-2 investigators state: The overall long-term glucose control was better in the second than in the first DIGAMI trial, which may have had a favourable influence on the outcome in the latter. Add comment Close comment form modal.
DIGAMI 2 trial post hoc analysis: Lessons in overinterpretation | MD Magazine
Considering the very small differences in mortality among the three management strategies, it is still not reasonable to assume that a larger patient material would have disclosed any clinically meaningful differences between the different glucose-lowering treatments. Conclusion DIGAMI 2 did not support digamk fact that an acutely introduced, long-term insulin treatment improves survival in type 2 diabetic patients following myocardial infarction when compared with a conventional management at similar levels of glucose cigami or that insulin-based treatment lowers the number of non-fatal myocardial reinfarctions dgami strokes.
The median study duration was 2. Your comment will be reviewed and published at the journal’s discretion. The Diabetic Coronary Patient. The protocol stated that patients in groups 2 and 3 should be treated at the discretion of the attending physician. Slow response to loss digaki glycemic control in type 2 diabetes mellitus. DIGAMI 2 did not support the fact that an acutely introduced, long-term insulin treatment improves survival in type 2 diabetic patients following myocardial infarction when compared with a conventional management at similar levels of glucose control or that insulin-based treatment lowers the number of non-fatal myocardial reinfarctions and strokes.
The most likely explanation is unfavourable patient allocation in this particular respect, not covered for by our attempt to cause a balanced randomization. Our findings have important dlgami for the analysis and interpretation of clinical studies.
Management of acute myocardial infarction in patients presenting with ST-segment elevation.
DIGAMI 2 trial post hoc analysis: Lessons in overinterpretation
The slow recruitment rate and the fact that some centres recruited relatively few patients explained the slight imbalance among the three groups because the randomization algorithm was not applied until eight patients were included in an individual centre.
Dgiami average increase in body weight was 4. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. Almost all remaining patients had coronary artery disease mostly presenting as unstable angina pectoris. In contrast, the continued glucose-lowering treatment in group 1 ddigami less effective than prescribed by the protocol.
Under-utilisation of evidence-based treatment partial explanation for the unfavourable prognosis in diabetic patients with acute myocardial infarction.
DIGAMI 2 was a multicentre, prospective randomized, open trial with blinded evaluation comparing three different management strategies in patients with type 2 diabetes and acute myocardial infarction. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus.
It had been postulated that insulin-based treatment should be superior to glucose-lowering therapy by means of oral glucose-lowering agents. Dekkers; study nurse, S. Eigami most likely reasons for this beneficial outcome are a combination of improved glucose control and an extensive use of evidence-based treatment as prescribed by the protocol.
Sample size was based on the 2 year mortality of patients with type 2 diabetes in the control group of the first DIGAMI trial. Finally, statistical adjustment for multiple variables is markedly limited with a small number of events. Thereafter, fasting blood glucose was recorded daily until hospital discharge and at each follow-up visit.