Article Text

PDF
Acute coronary syndromes
Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardial infarction in patients with type 2 diabetes: a report from the DIGAMI 2 trial
  1. L G Mellbin1,
  2. K Malmberg1,
  3. A Waldenström2,
  4. H Wedel3,
  5. L Rydén1,
  6. for the DIGAMI 2 investigators
  1. 1
    Karolinska Institutet, Stockholm, Sweden
  2. 2
    University Hospital, Umeå, Sweden
  3. 3
    Nordic School of Public Health, Göteborg, Sweden
  1. Dr Linda G Mellbin, Cardiology Unit, Institution of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden; linda.mellbin{at}karolinska.se

Abstract

Objective: To explore if hypoglycaemic episodes during hospitalisation influence the subsequent prognosis in patients with diabetes and acute myocardial infarction.

Design, setting and patients: Within the framework of the clinical trial DIGAMI 2 hypoglycaemic episodes (blood glucose <3.0 mmol/l with or without symptoms) were recorded in 1253 patients (mean age 68 years; 67% males) with type 2 diabetes and myocardial infarction. The patients were followed during a median of 2.1 years. A total of 947 patients were randomised to an initial insulin infusion while 306 received routinely used glucose lowering therapy.

Main outcome measures: Unadjusted and adjusted (age, sex, smoking, previous infarction, heart failure, renal function, diabetes duration, coronary interventions, pharmacological treatment and B-glucose at hospital admission) hazard ratios (HR) and 95% confidence intervals (CI) for total mortality and cardiovascular events (death, re-infarction or stroke) were related to hypoglycaemic episodes during the index hospitalisation.

Results: During the first 24 hours hypoglycaemic episodes were noted in 111 (12%) insulin-treated (symptomatic 23%) and three (1.0%) routinely treated patients (symptomatic 33%). Symptomatic hypoglycaemia related to mortality (unadjusted HR 1.99; 95% CI 1.20 to 3.29; p = 0.0074) but this difference disappeared following adjustment (HR 1.09; 95% CI 0.64 to 1.87; p = 0.7403). Body weight (OR 0.97; 95% CI 0.95 to 0.98; p<0.0001) and diabetes duration (OR 1.03; 95% CI 1.01 to 1.05; p = 0.0085) were independent predictors of hypoglycaemia

Conclusions: Hypoglycaemia during the initial hospitalisation was not an independent risk factor for future morbidity or mortality in patients with type 2 diabetes and myocardial infarction. Such episodes were, however, more prevalent in patients at high risk for other reasons.

Statistics from Altmetric.com

Footnotes

  • Funding: Supported by the Swedish Heart-Lung Foundation, AFA Insurance and by unconditional research grants from Aventis Sweden and Novo Nordisk Denmark.

  • Competing interests: KM is professor of cardiology at Karolinska Institutet, Stockholm for 25% of his time and employed by AstraZeneca for 75%. This company has not been involved in the trial and has no interest in this paper.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.