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

<p>Abstract</p> <p><br></p> <p>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. </p> <p><br></p> <p>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. </p> <p><br></p> <p>Results: At median follow‐up of 29.7months, 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. </p> <p><br></p> <p>Conclusion: The introduction of a joint‐speciality cardiodiabetes service improved the care and survival of patients with acute coronary syndrome and diabetes mellitus.</p>