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Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardial infarction in patients with type 2 diabetes: a report from the DIGAMI 2 trial.
Heart. 2009 May; 95(9):721-7.H

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.

Authors+Show Affiliations

Cardiology Unit, Institution of Medicine, Karolinska Institutet, Stockholm 171 76, Sweden. linda.mellbin@karolinska.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19029171

Citation

Mellbin, L G., et al. "Prognostic Implications of Hypoglycaemic Episodes During Hospitalisation for Myocardial Infarction in Patients With Type 2 Diabetes: a Report From the DIGAMI 2 Trial." Heart (British Cardiac Society), vol. 95, no. 9, 2009, pp. 721-7.
Mellbin LG, Malmberg K, Waldenström A, et al. Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardial infarction in patients with type 2 diabetes: a report from the DIGAMI 2 trial. Heart. 2009;95(9):721-7.
Mellbin, L. G., Malmberg, K., Waldenström, A., Wedel, H., & Rydén, L. (2009). Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardial infarction in patients with type 2 diabetes: a report from the DIGAMI 2 trial. Heart (British Cardiac Society), 95(9), 721-7. https://doi.org/10.1136/hrt.2008.152835
Mellbin LG, et al. Prognostic Implications of Hypoglycaemic Episodes During Hospitalisation for Myocardial Infarction in Patients With Type 2 Diabetes: a Report From the DIGAMI 2 Trial. Heart. 2009;95(9):721-7. PubMed PMID: 19029171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardial infarction in patients with type 2 diabetes: a report from the DIGAMI 2 trial. AU - Mellbin,L G, AU - Malmberg,K, AU - Waldenström,A, AU - Wedel,H, AU - Rydén,L, AU - ,, Y1 - 2008/11/24/ PY - 2008/11/26/pubmed PY - 2009/5/13/medline PY - 2008/11/26/entrez SP - 721 EP - 7 JF - Heart (British Cardiac Society) JO - Heart VL - 95 IS - 9 N2 - 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. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/19029171/Prognostic_implications_of_hypoglycaemic_episodes_during_hospitalisation_for_myocardial_infarction_in_patients_with_type_2_diabetes:_a_report_from_the_DIGAMI_2_trial_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&amp;pmid=19029171 DB - PRIME DP - Unbound Medicine ER -