Evaluating the Effectiveness of Insulin Plus Oral Medications Versus Oral Anti-Diabetes Therapy Alone in Patients With Newly Diagnosed Type 2 Diabetes With Very High hbA1c and Acute Coronary Syndrome

Introduction

Many patients with Acute Coronary Syndrome (ACS) are newly diagnosed with Type 2 Diabetes Mellitus (T2DM) with very high hbA1c levels (> 10%). Early achievement of glycaemic control is of prime importance in such cases, and many guidelines recommend starting insulin together with oral anti-diabetic drugs (OAD) as part of discharge medications. However, large numbers of treatment-naïve patients are hesitant to use insulin due to various factors.

Methods

In this retrospective, single-centre, observational study, we compared the hbA1c at 1-year follow-up between newly diagnosed DM patients with initial hbA1c > 10% who were discharged on insulin plus OAD versus those only on OAD after admission with ACS. Pairwise comparisons between continuous and categorical study variables were performed using t-test, Mann–Whitney test, and chi-square. We used STATA 18 for analysis. Baseline characteristics have been described for all the patients included in the study. In the analysis of outcomes at follow-up, only patients who had follow-up at 1-year were included.

Results

Of 149 patients eligible for inclusion, the majority were males (97.3%). The mean age was 47 ± 8.3 years. The baseline hbA1c at diagnosis was 11.2 (10.5–12.3) %. 38 (25.5%) Were Discharged on insulin + OADs, whereas 111 (75.5%) Were Discharged Only on OADs. There was no statistically significant difference in change in hbA1c from baseline between the two groups (Mean (SD) 4.4% ± 1.8% vs. 4% ± 1.5%, p = 0.07). None of the patients had any hyperglycaemic emergency, and there were no differences in recurrent admissions due to cardiac indications (p = 0.5).

Conclusion

An anti-DM regimen consisting of multiple oral agents is a safe and effective alternative to insulin plus OAD and can lead to a comparable reduction in hbA1c at 1-year in patients who are not willing to use insulin early after diagnosis of T2DM.