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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn the Diabetes Mellitus-Glucose Infusion in Acute Myocardial Infarction [DIGAMI] study, insulin-glucose infusion, followed by multidose insulin treatment, improved long-term prognosis in diabetic patients with acute myocardial infarction (AMI) at 1 year [Malmberg K et al. \u003Cem\u003EJ Am Coll Cardoiol\u003C\/em\u003E 1995]. This article discusses recent data from the extended follow-up (maximum 8.3 years; median 4.1 years) for 1145 subjects in the DIGAMI 2 study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAcute myocardial infarction (AMI) in patients with diabetes increases the risk of poor outcome. In the Diabetes Mellitus-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study, insulin-glucose infusion, followed by multidose insulin treatment, improved long-term prognosis in diabetic patients with AMI at 1 year [Malmberg K et al. \u003Cem\u003EJ Am Coll Cardoiol\u003C\/em\u003E 1995].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn DIGAMI 2, patients with type 2 diabetes or blood glucose \u0026gt;11 mmol\/L and suspected myocardial infarction (MI) were randomized to one of three treatment strategies: Group 1\u2013acute insulin-glucose infusion followed by insulin-based long-term glucose control (n=474); Group 2-insulin-glucose infusion followed by standard glucose control (n=473); or Group 3\u2013routine metabolic management according to local practice (n=306) [Malmberg K et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2005]. Subjects were treated for a mean of 2.1 years and, in an extended part of the trial, followed up for a maximum of 8.3 years (median 4.1). At the end of the study, there were no significant differences in morbidity, expressed as nonfatal reinfarctions and strokes, among the three groups. The data did suggest that glucose level is a strong, independent predictor of long-term mortality in this patient category, indicating that glucose control seems to be an important part of their management.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EResults of a later post hoc analysis from DIGAMI 2, assessing the impact of glucose-lowering treatment with insulin, sulfonylureas, or metformin on long-term mortality and morbidity prognosis, showed no significant difference in mortality between the three treatments. The risk of nonfatal MI and stroke increased significantly with insulin, while metformin was protective [Mellbin LG et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ELinda Mellbin, MD, Department of Cardiology, Karolinska Institutet, Stockholm, Sweden, discussed recent data from the extended follow-up (maximum 8.3 years; median 4.1 years) for 1145 subjects in the DIGAMI 2 study. Total mortality was 34% (24% cardiovascular [CV]; 9.5% malignancies). Cox regression analysis did not show any difference in total or CV mortality among the treatment groups. The total number of fatal malignancies was 37, with the highest risk in Group 1 (HR vs Group 2, 1.83; 95% CI, 0.90 to 3.71; p=0.10 and Group 3, 3.57; 95% CI, 1.22 to 10.39; p=0.02). Treatment with insulin was associated with a significant increase in the risk of nonfatal MI and stroke (OR, 1.90; 95% CI, 1.38 to 2.60; p\u0026lt;0.0001) but not mortality (OR, 1.30; 95% CI, 0.94 to 1.80; p=0.11), while metformin was associated with a lower mortality (HR, 0.65; 95% CI, 0.47 to 0.90) and a lower risk of death due to malignancies (HR, 0.25; 95% CI, 0.08 to 0.83).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ELong-term mortality is high after MI in patients with type 2 diabetes. The drug that is used for glucose control appears to have a prognostic impact. Prof. Mellbin suggested that the beneficial effects of metformin may be due to 5\u0027 AMP-activated protein kinase-induced improved endothelial function, tumor suppression, and increased insulin sensitivity. The negative effects of insulin were attributed to it being proatherogenic, its effect on the insulin-like growth factor-1 axis, survival and proliferation of malignant cells, and hypoglycemia.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/9\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmo4d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}