- Question
- Does an intensive metabolic control strategy based on insulin, started acutely and continued long term, improve survival in patients with type 2 diabetes after acute myocardial infarction compared with conventional management?
- Design
- Randomized, open-label, three-group trial enrolling 1253 patients (mean age 68 years; 67% male). Median study duration was 2.1 years.
- Population
- Patients with type 2 diabetes and suspected acute myocardial infarction.
- Intervention
- Group 1: acute insulin-glucose infusion followed by insulin-based long-term glucose control. Group 2: insulin-glucose infusion followed by standard glucose control.
- Control
- Group 3: routine metabolic management according to local practice, without insulin-glucose infusion.
- Primary outcome
- All-cause mortality, comparing groups 1 and 2. Comparison of mortality between groups 2 and 3 was the secondary objective, and morbidity (non-fatal reinfarction and stroke) the tertiary objective.
- Results
- Mortality did not differ between group 1 (23.4%) and group 2 (22.6%): HR 1.03; 95% CI 0.79-1.34; P=0.831. Nor did it differ between groups 2 and 3 (19.3%): HR 1.23; 95% CI 0.89-1.69; P=0.203. There were no significant differences in non-fatal reinfarction or stroke.
- Conclusion
- Insulin treatment introduced acutely and continued long term did not improve survival or reduce non-fatal events compared with conventional management at similar levels of glucose control.
- Why it matters
- The trial indicated that the benefit seen in the original DIGAMI was not reproduced with an insulin-based strategy, although its findings suggested that blood glucose remains an important independent predictor of long-term mortality and that its control is a relevant part of management.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026