The Diabetes mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 2 Quality of Life (QoL) sub-study included 465 patients with type 2 diabetes and acute myocardial infarction (AMI) followed for 2 years. Self-rated health was reported by the rating scale (RS), graded 0 = death to 100 = perfect health. Prospective associations between RS and all-cause mortality, cardiovascular (CV) death and cardiovascular events (CVEs = CV death, non-fatal AMI, stroke) were assessed. Median age was 68 years (range 59-74), 68% male. Patients experiencing CVE (n = 132) or death (n = 71) had lower RS compared with patients free from events: 60 (50-79) versus 70 (55-81) (p < 0.001) and 60 (50-75)

OBJECTIVELeft ventricular diastolic dysfunction (LVDD) is considered to be common in patients with type 2 diabetes mellitus (T2DM), but information on its progression over time is lacking. We studied the longitudinal development of left ventricular diastolic function (LVDF) and myocardial blood flow reserve in patients with T2DM who were free from clinically detectable cardiovascular disease. RESEARCH DESIGN AND METHODSThe LVDF was assessed in 73 patients with T2DM (mean age 67 6 7 years; males 51%) on two occasions separated by 6.4 6 0.8 years. RESULTSAt baseline, LVDD was observed in 23 of the patients (32%). During follow-up, the LVDF normalized in 10 of these patients (43%) and remained unchanged in 13 of them (57%). Of the 50 patients (68%) with normal LVDF at baseline, LVDD developed in 9 (18%). Paired evaluation of myocardial blood volume index was available from 22 patients with LVDD and remained unchanged over time. CONCLUSIONSThe condition of the majority of the investigated patients with LVDD improved or remained stable over a period of 6 years.Myocardial dysfunction, in particular relaxation disturbances, occurs in patients with type 2 diabetes even in the absence of such conditions as hypertension and coronary artery disease (1). The background structural and functional changes relate to glucometabolic perturbations (2,3), but factors such as increasing age, obesity, hypertension, and coronary artery disease may also contribute to myocardial stiffness (4), and often coexist in patients with diabetes.Left ventricular diastolic dysfunction (LVDD) is characterized by echocardiographic indices of impaired early diastolic filling, prolonged isovolumetric relaxation (5), and also, in more advanced stages, increased atrial volume (6). It has been referred to as a progressive condition increasing the risk for subsequent overt heart failure and compromised survival (7,8). The prevalence of LVDD in patients with type 2 diabetes has been estimated to be between 35% and 60% (9-11). The wide range is mainly explained by varying definitions of LVDD, applied echocardiographic techniques, and population characteristics. Considering the rather high prevalence of LVDD, a better understanding of its time-dependent development may identify high-risk populations as well as create opportunities to prevent or at least delay its progression. However, longitudinal studies of the natural course of left ventricular diastolic function (LVDF) in patients with type 2 diabetes who were free

The second Diabetes Glucose and Myocardial Infarction (DIGAMI 2) study randomised patients with diabetes and myocardial infarction to insulin or oral-based treatment. To determine the effects of insulin-based treatment, the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the Psychological General Well-Being (PGWB) Index were administered at baseline and 12 months. Insulin-treated patients (n = 197) had a worse risk profile and more co-morbidity at baseline than patients on oral glucose-lowering agents (n = 127). The treatment satisfaction and psychological wellbeing was similar between insulin and oral groups at baseline . Improvement was significant in both groups. Insulin-based therapy was well accepted and did not decrease treatment satisfaction or psychological well-being compared to oral glucose-lowering treatment in patients with type 2 diabetes and myocardial infarction.

Abstract. Venskutonyte L, Malmberg K, Norhammar A, Wedel H, Rydén L (Karolinska Institute, Stockholm; and Nordic School of Public Health, Göteborg; Sweden). Effect of gender on prognosis in patients with myocardial infarction and type 2 diabetes. J Intern Med 2010; 268: 75-82.Background. Diabetes is associated with a markedly increased cardiovascular risk, but the role of gender on the combined effects of diabetes and myocardial infarction has been less well explored.

Key words: acute heart failure; chronic decompensated heart failure; pulmonary edema; cardiogenic shock; right heart failure. Summary