May 21, 2014
Intensive Insulin Therapy Prolongs Life in Post-AMI Diabetics

Stockholm, Sweden—Intensive insulin treatment extended life by more than 2 years after acute myocardial infarction (AMI) in patients with diabetes compared with standard treatment, according to a new Swedish study.

The report, based on long-term follow-up of the DIGAMI 1 trial—a landmark study of type 2 diabetes in Sweden—was published recently in The Lancet Diabetes & Endocrinology. The study was designed to determine whether a difference in intensity of treatment affected all-cause mortality in the long term after AMI.

For the trial, researchers from the Karolinska Institute followed 620 patients with type 2 diabetes, beginning in 1990. Patients who were admitted to hospital with a suspected heart attack received an insulin-glucose infusion for at least 24 hours, followed by insulin injection four times a day for at least 3 months or standard glucose-lowering treatment, which only rarely involved insulin, for 1 year.

During the 20-year study period, most of the patients died of some cause. Results indicate, however, that those who received intensified insulin treatment during the trial survived a median of 2.3 years longer compared with those who received standard treatment.

The effect was apparent for at least 8 years after randomization before leveling off, according to the study. The greatest benefit from the intensive insulin treatment was for patients who appeared to be at low cardiovascular risk, were less than 70 years old, had no history of heart attack or congestive heart failure, and had not previously had insulin therapy.

The authors note that, although the results clearly show a benefit of intensive insulin treatment after a heart attack in patients with type 2 diabetes, the effect on survival is probably greater than if the trial was started today. The reason, they explain, is because of advances in conventional treatment of patients with type 2 diabetes and cardiovascular complications, including statins and angiotensin-converting-enzyme inhibitors.

In an accompanying commentary, Denise Bonds, of the National Institutes of Health in Bethesda, MD, agrees, saying the new study “points to the benefit of good glucose control even when other risk factors such as lipids or blood pressure cannot be or are not modified…it provides an important reminder of how quickly medicine is advancing, something that is often forgotten in the busy day-to-day practice of medicine. In 20 years, we have gone from few glucose-lowering therapies to over half a dozen oral therapy drugs, plus insulin, plus effective treatments to reduce the risk of elevated lipids and blood pressure. Now, the challenge is choosing the best treatment option for our patients.”

U.S. Pharmacist Social Connect