Prevalence and clinical significance of uncontrolled diabetes mellitus in patients presenting with acute coronary syndrome

Background: In cases of acute coronary syndrome (ACS) at admission, increased glucose concentrations are a significant independent predictor of death in the hospital and are even more important for cases who do not have known diabetes mellitus (DM). Purpose: The aim of the study was to know the prevalence of uncontrolled DM in the Aswan government among patients presenting with ACS and its impact on the severity of coronary artery disease (CAD) in comparison with patients without DM or with controlled DM. Methods: A prospective observational study was conducted in the Cardiology Department, Aswan University Hospital throughout the duration from March 2023 to March 2024. This research included 300 diabetic patients presented with new-onset ACS. All the patients underwent coronary angiography during the hospital course. Results: The mean level of hemoglobin A1C (HbA1C) was 9.2 ± 1.7 mmol/l, and accordingly, cases were categorized into controlled DM (<7) in 13% ( n = 39) and uncontrolled DM in 87% ( n = 261). According to coronary angiography findings, 89% ( n = 267) of cases had proximal lesion, 60% had middle lesion ( n = 181), and only 12% had distal lesion. Regarding the severity of stenosis, the majority of cases (92.7%, n = 278) had severe stenosis, about one-fifth (21.7%, n = 65) had mild stenosis and about one-fifth (19.3%, n = 58) had moderate stenosis. Conclusion: The prevalence of uncontrolled diabetes was higher among patients presented with ACS, and the rate of severe CAD lesions was significantly higher among uncontrolled DM group compared with the controlled DM group, and most of the lesions were proximal.