Abstract
AbstractHyperglycaemia in the setting of acute illness carries a poor prognosis. The first Diabetes and Insulin‐Glucose infusion in Acute Myocardial Infarction (DIGAMI) study demonstrated a reduction in total mortality with intravenous insulin to reduce hyperglycaemia followed by multi‐dose subcutaneous insulin in diabetic patients following myocardial infarction. Unfortunately, there were several problems with the follow‐up DIGAMI‐2 study, so that it is not clear if maximum benefit was obtained by intravenous insulin, subcutaneous insulin, or a combination of both. In the surgical intensive care unit (ICU) setting, intensive insulin to restore normoglycaemia reduced total mortality in patients admitted to a surgical ICU who developed hyperglycaemia. In a follow‐up study in medical ICU patients the results were disappointing, and there was no overall reduction in mortality. There is a need for a study which would combine these two complementary approaches, examining the possible benefits of using very intensive insulin treatment to achieve normoglycaemia following myocardial infarction in patients with diabetes. Copyright © 2007 John Wiley & Sons.
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