Optimisation of care among patients with diabetes mellitus and acute coronary syndrome through a specialised cardiodiabetes service-A registry study.

Abstract

Aims: Diabetes mellitus remains a prevalent condition worldwide and a significant risk factor for atherosclerotic cardiovascular disease. Recent evidence suggests the use of glucose-lowering therapies with cardiovascular benefit in optimising the cardiometabolic profile of patients with type 2 diabetes mellitus. However, uptake remains low. This study was carried out to assess the impact of a novel cardiodiabetes service for the management of patients with diabetes mellitus presenting with acute coronary syndromes.

Methods: A retrospective, observational, registry-based analysis was performed among patients presenting with an acute coronary syndrome and diabetes mellitus to a regional heart centre before and after the implementation of a cardiodiabetes service. Intergroup comparison was made for the proportion of patients having a valid glycated haemoglobin during admission, initiation of guideline-recommended glucose and lipid-lowering therapies.

Results: At median follow-up of 29.7 months, a valid HbA1c measurement at baseline was lower in the pre-intervention compared to the post-intervention group (556/711 [78.2%] vs. 302/362 [83.4%], p = 0.043) while more patients in the post-intervention group were prescribed sodium-glucose co-transporter inhibitors (297/362 [82.0%] vs. 359/711 [50.5%]). All-cause mortality (5.2 vs. 12.3 [events/100 patient-years], relative ratio [RR] 0.42, 95% confidence interval [CI] 0.28-0.61, and p < 0.001), first events of acute kidney injury (AKI) (10.0 vs. 13.0, RR 0.77, CI 0.57-1.03, p = 0.090) and all events of AKI (16.6 vs. 22.1, RR 0.75, CI 0.60-0.94, p = 0.015) were significantly lower in the post-intervention group.

Conclusion: The introduction of a joint-speciality cardiodiabetes service improved the care and survival of patients with acute coronary syndrome and diabetes mellitus.