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The UGDP trial
showed no overall beneficial effect of a sulphonylurea, a giguamide, nor insulin on MI
rates. Both oral drugs had serious potential adverse outcomes. A two year pilot study by
the Veterans Administration (VACSDM) in sulphonylurea failure, obese Type 2 diabetics
showed that intensive therapy with insulin appeared to have borderline negative
effect on cardiovascular outcome. The Kumamoto study as previously described was too small
to allow meaningful interpretation, while the DIGAMI study was a different type of study
wherein patients with diabetes and acute myocardial infarction were treated with insulin
infusion from admission and were followed subsequently for a year. Most of their post
hospital discharge therapy however was not controlled. Nonetheless, a very significant and
continuing benefit was seen for the early insulinization of these patients at the time of
their MI. The DCCT trial described earlier did not have enough macrovascular events to
permit any conclusions to be drawn.
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