Significant Mortality Benefit for Insulin Therapy at 20 Years — But Is the Finding Still Relevant? — Physician’s First Watch
Significant Mortality Benefit for Insulin Therapy at 20 Years — But Is the Finding Still Relevant?
By Larry Husten
A trial that started back in 1990 continues to demonstrate a significant mortality advantage for intensive insulin therapy in myocardial infarction patients, according to a Lancet Diabetes and Endocrinology article. But, experts say the trial is so outdated that the findings should have no influence on clinical practice today.
From 1990 through 1993, Swedish researchers randomized 620 MI patients with elevated glucose levels to either intensive insulin treatment or conventional therapy. Earlier results from the trial showed beneficial effects, including improved survival, for patients in the intensive-treatment arm. Now, 20-year follow-up results show a 2.3-year increase in survival with intensive treatment (median survival, 7.0 vs. 4.7 years).
One expert notes that the patients were less likely to receive now-proven therapies like ACE inhibitors and statins (statins weren't even available at the study's start). And another expert speculates that many more control patients may have been treated with sulfonylureas, which may have adverse cardiovascular effects. "This suggests the contrast [between groups] is not because insulin was better, but that 'control' was worse," he says.