DIGAMI (Diabetes mellitus, insulin glucose infusion in acute myocardial infarction): Theory and practice

There appears to be irrefutable evidence of the association between hyperglycaemia and poor outcome following AMI, and the benefits of GIK infusions given acutely following an AMI. The DIGAMI study has demonstrated that the use of an insulin-glucose infusion followed by long-term subcutaneous insulin therapy has significant survival benefit for diabetic patients with an AMI, which compare favourably to other standard interventions. Whereas there are some limitations of the DIGAMI study, particularly in terms of lack of a clear explanation of the mechanism for the benefit observed, it provides the best data that we have available and the clear survival benefit for patients should not be overlooked. The results of DIGAMI justify the long-term use of subcutaneous insulin in these patients following AMI. To ensure smooth implementation of DIGAMI, minor modifications of the protocol may need to be made, and extra resources, particularly with regard to DSNs, will be required.