[en] Clinical Trials as Topic/ethics ; Diabetes Complications/drug therapy ; Diabetes Mellitus, Type 2/complications/drug therapy ; Humans ; Insulin/administration & dosage/adverse effects ; Myocardial Infarction/complications ; Pilot Projects
[en] The results of DIGAMI-2 (<<Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction>>) trial were presented at the 40th scientific congress of the European Association for the Study of Diabetes (EASD) in Munich on September 6, 2004. The main objective of this multicentre international trial was to confirm the positive results of the first DIGAMI trial published in 1995--1997. This pilot trial demonstrated that insulin-glucose infusion followed by a subcutaneous multidose insulin regimen reduces total mortality after 1 and 3 years in diabetic patients with acute myocardial infarction. DIGAMI-2, by comparing three groups of subjects receiving various interventions, aimed at determining the relative benefit resulting from the insulin-glucose infusion in the acute phase and that attributable to long-term intensive insulin therapy in a similar population of type 2 diabetic patients. No significant difference was observed between the three groups as far as total mortality and cardiovascular morbidity were concerned. These negative results may be explained by the absence of significant difference in blood glucose control between the three groups, by the fact that glycaemic targets were not reached in the intensive group and, last but not least, by a better management of other risk factors, allowing already markedly reduced cardiovascular morbidity and mortality in the reference group treated with conventional antidiabetic therapy. In conclusion, DIGAMI-2 argues for a multidisciplinary management of diabetic patients to reach strict glycaemic targets with an intensive insulin scheme and confirms the remarkable advances in cardiovascular protection thanks to an optimised global pharmacological approach combined with modern revascularisation procedures.