Clinicians managing patients with diabetes hospitalized for acute myocardial infarction should be aware that randomized DIGAMI data reported a mortality benefit associated with an initial insulin‑glucose infusion followed by long‑term subcutaneous insulin ^[4][6]. The DIGAMI program supports that an intensive metabolic approach in this population was associated with lower long‑term mortality and that close monitoring for hypoglycemia and electrolyte changes is required during infusion ^[4][5]. Was the observed long‑term mortality reduction driven primarily by the initial infusion, the subsequent long‑term subcutaneous insulin, or both?

Q1 What did the DIGAMI trial show?

A1 The DIGAMI program tested an initial insulin‑glucose infusion of at least 24 hours followed by long‑term subcutaneous insulin versus conventional therapy in patients with diabetes and acute myocardial infarction and reported a 25% reduction in long‑term relative mortality at 3.4 years in the insulin‑treated group. A prestratified subgroup without prior insulin treatment experienced a 45% mortality reduction at 3.4 years. The trial program therefore reported an association between an intensive metabolic strategy and improved long‑term survival in this population.

Q2 Who was enrolled in DIGAMI?

A2 The DIGAMI studies enrolled patients with diabetes who presented with acute myocardial infarction. A feasibility multicenter report randomized 327 patients with suspected acute MI (158 to insulin‑glucose infusion and 169 to conventional therapy) and documented early metabolic and safety outcomes during infusion. Subsequent analyses and cost‑effectiveness work were based on randomized trial cohorts that included 620 patients in the primary randomized trial population.

Q3 What were the side effects reported in DIGAMI?

A3 During the feasibility insulin‑glucose infusion, hypoglycemia occurred; 28 of 158 patients in the infusion group developed blood glucose < 3.0 mM. Serum potassium fell modestly in the infusion group (decrease 0.21 ± 0.56 mM), and there were no significant differences in ventricular tachyarrhythmias or ischemic events between patients with and without hypoglycemia in that report. Product labels for marketed insulins also list hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, and rash as adverse reactions.

Q4 What does DIGAMI mean for clinical practice?

A4 DIGAMI indicates that an approach combining an initial insulin‑glucose infusion followed by long‑term subcutaneous insulin was associated with lower long‑term mortality in patients with diabetes and acute myocardial infarction in randomized analyses, and it emphasizes the need for close glucose and electrolyte monitoring when using insulin infusions. However, the program did not definitively isolate whether benefit derived from the acute infusion or the subsequent long‑term subcutaneous regimen alone.

Clinicians should consult current prescribing information for complete dosing guidance.