Insulin infusion in diabetic patients with acute myocardial infarction

Effective in diabetes, but patients with glucose intolerance may also benefit

Despite the improvements brought about by thrombolysis, β blockade, and treatment with angiotensin converting enzyme inhibitors, the mortality in diabetic patients admitted to hospital for acute myocardial infarction remains up to twice that in non-diabetic patients matched for age and sex.1 This increased mortality is apparent both during hospital stay and at longer term follow up in a range of populations, including white Americans,2 Mexican-Americans,3 and people from the Asian subcontinent.4

The excess mortality is shared by those with diabetes already diagnosed and those with previously undiagnosed diabetes.3 5 The higher mortality of diabetic patients compared with non-diabetic patients is not explained by differences in the extent or severity of coronary artery disease or by differences in infarct size.6 7 8 In patients with longstanding diabetes, complications such as microvascular disease and autonomic neuropathy could predispose to poorer outcome. A more specific reason for poor outcome is the high incidence of cardiac failure in diabetic patients with myocardial infarction, which is also not explained by differences …