Are our acute coronary syndrome patients achieving better glycaemic control after admission? : a study

Abstract

BACKGROUND: Diabetes mellitus (DM) is a cardinal cardiovascular risk factor. Tight glycaemic control is advocated as part of primary and secondary cardiovascular disease prevention. The aim of this study was to investigate the impact of acute coronary syndrome (ACS) admission on subsequent glycaemic control in known type I/II DM patients.

METHODS: Patients were included if (a) known to have type I/type II DM prior to admission (b) admitted with ACS under the care of a cardiologist between January and December 2020 and (c) in possession of a haemoglobin A1c (HbA1c) result within 6 weeks of index admission (peri-admission) and a repeat result around 6 months thereafter (follow-up). Peri-admission and follow-up HbA1c levels were compared using Wilcoxon signed-rank test.

RESULTS: One hundred and seventy patients [124 (72.9%) male; mean age 67.88 ± 10.18 years] were included. During index admission, a change in DM treatment was performed in 80 (47.1%) patients, while a diabetology review was requested for 37 (21.8%) patients. A significant reduction in HbA1c levels was demonstrated following an ACS admission with a peri-admission median level of 7.5% (IQR 2.3%) to a follow-up median of 7.1% (IQR 1.7%) (Z statistic -4.145, p<0.001), although at 6 months 119/170 (70%) patients still had an HbA1c above the 6.5% target.

CONCLUSION: Changes in DM treatment and/or advice during ACS admission appear to have an initial beneficial impact on glycaemic control in known diabetics. Aggressive long-term control is necessary to ensure more effective risk reduction.