Tuesday - Dec 10, 2019

Insulin Therapy Improves Survival of Heart Attack


Diabetes woman patient make an abdomen subcutaneou

Diabetes and heart ailments are two of the debilitating illness that impedes the quality of life of a patient suffering from this condition.    Thus, through the years a lot of studies were conducted to prolong and improve the quality of life of the affected individuals.  The Center for Disease and Control Prevention recently reported that the five main complications associated with diabetes such as stroke, heart attack, lower-limb amputation, and kidney failure and increase morbidity from high blood sugar levels were lessened in the United States for the past 20 years.

A recently published journal from The Lancet Diabetes and Endocrinology entitled “Intensive Insulin Provides Survival Benefits in Patients with Type 2 Diabetes after Heart Attack, showed significant and promising results that will help enhance the survival rate of diabetic patients who survived after having a heart attack.  The long-term trial was reported by Dr. Viveca Ritsinger and her colleagues, which they called DIGAMI 1 or Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction which is said to be a landmark for type 2 Diabetes in Sweden. Dr. Ritsinger is associated with the Unit of Cardiology in the Department of Medicine, Karolinska Institute, Stockholm, Sweden. 

The long-term study showed that intensive insulin therapy can prolong the life of the patients with this condition for another two years as compared with having a standard treatment or therapy for diabetes.   The follow-up trial involves 620 patients who have a Type 2 diabetes. The study began in 1990 and the patients who were selected in the study were those admitted in the hospital because they were suspected for other complications associated with diabetes which is heart attack. 

Patients received an intensive therapy for insulin or a standard glucose-lowering treatment for one whole year.  Patient were given an insulin-glucose infusion in 24 hours and then followed by an insulin injection which is given four times per day for almost 3 months. The other group was given standard glucose-lowering treatment which rarely received some insulin and it was given for a year.  The study was conducted to determine the long-term effects of insulin therapy and if there will be a difference in treatment based on the mortality rate.

The follow-up study lasted for almost 20 years. Some of the patients who participated in the study have died already.  The result showed that those who received an intensified treatment for insulin survived an average of two to three years longer as compared with those who got a standard treatment. The result was evident for almost 8 years and then it levelled off. The researchers also noted that there is 50% survival improvement when the intensified insulin treatment was given to patients.

According to the researchers, those who benefited the most in the intensive treatment for insulin were those patients who are at low risk for cardiovascular disease.  These are the patients who are 70 years of age and below with no any history of congestive heart failure and or heart attack.  They also did not have any previous treatment of insulin therapy when the study started. The survival of these patients was extended from 6.9 years to 9.4 years after experiencing a heart attack from diabetes complications.

The intensive insulin therapy was effective for patient with low cardiovascular risk but not for patients who are having high cardiovascular risk.  The study showed no significant outcome with high risk patients who had no any experience of insulin treatment.  Patients who are at high risk of cardiovascular disease are those who had a heart attack and they are 70 years old and above.

The researchers also noted that if the study was conducted today, the probability of having positive outcome is larger.  This is because when the DIGAMI 1 study began, there were already advances in the treatment of patients with type 2 diabetes which are also having cardiovascular complications. The use of statin medication which helps lower cholesterol and blood pressure levels with the aid of ACE or angiotensin-converting-enzyme inhibitors are the currently trusted methods that are widely prescribed by physicians worldwide.

Dr. Denise Bonds of the National Institutes of Health in Bethesda, USA, also said that the study offers an essential reminder that the field of medicine is quickly advancing.    She also mentioned that in just a span of 20 years, newer and effective treatment options were discovered to help more patients.  From glucose-lowering therapies, physicians are now offering more advance treatment to lessen the risk of increase lipid profile and blood pressure.

The challenge today is for the clinicians, how they will be able to choose the best treatment option for their patient.  There are many treatments now that are effective for a specific medical condition considering that medications are now targeting the molecular level of the treatment.  Clinicians who are more adept and specialized with how the body system’s work particularly with the mechanisms of receptors and inhibitors, have a better chance of providing effective treatment for their patients.