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 29.7months, 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 Conclusion: The introduction of a joint‐speciality cardiodiabetes service improved the care and survival of patients with acute coronary syndrome and diabetes mellitus.</p

Decrease in cardiovascular outcomes with SGLT2i in type 2 diabetes mellitus and acute coronary syndrome

Aims:To assess the impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors when prescribed at discharge on the reduction of major cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) presenting with acute coronary syndrome (ACS).Methods:A retrospective, registry-based, observational study of T2DM patients surviving an ACS event, eligible for an SGLT2i between July 2018 and December 2023. Comparisons were made between patients receiving SGLT2i’s at discharge with those who never received it or were prescribed post-discharge. The primary outcome was the proportion of patients having a MACE event (i.e., a composite of first events of hospitalisation for heart failure, coronary, cerebrovascular events or all-cause death). Inter-group survival analysis was performed using propensity score-matched Kaplan-Meier survival analysis, univariate and multivariate Cox regression models.Results:Of 970 patients, 313 received an SGLT2i at discharge, 330 post-discharge, while 327 patients never received it. The incidence of primary outcome was 19%, 23% and 43% respectively. Receiving SGLT2is at discharge significantly reduced the risk of MACE (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.33-0.60, pConclusion:Discharge SLGT2i therapy reduces MACE events in T2DM-ACS patients in comparison to SGLT2i naïve patients.</p

Reduction in acute kidney injury with sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and acute coronary syndrome

Aims:To assess the impact on reduction in the incidence of post-discharge acute kidney injury (AKI) with sodium-glucose cotransporter-2 (SGLT2) inhibitors when prescribed at discharge in patients with type2 diabetes mellitus (T2DM) presenting with acute coronary syndrome (ACS) over 24 months.Methods:A retrospective, registry-based, observational study of T2DM patients surviving an ACS event, eligible for an SGLT2i between July 2018 and December 2023. Comparisons were made between patients receiving SGLT2i’s at discharge with those who never received it or were prescribed post-discharge. The primary outcome was the proportion of patients having a first event of AKI. Inter-group survival analysis was performed using cumulative incidence curves, univariate and multivariate Cox regression models, followed by a Fine-Gray model to account for confounding factors.Results:Of 970 patients, 313 received an SGLT2i at discharge, 330 post-discharge, while 327 patients never received it. The incidence of primary outcome was 13%, 17% and 25% respectively with an overall incidence of 18%. Receiving SGLT2is at discharge significantly reduced the primary outcome (hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.34-0.73, pConclusion:Discharge SLGT2i therapy reduces AKI events in T2DM-ACS patients in comparison to SGLT2i naïve patients.</p

Diagnosis and management of type 2 diabetes mellitus in patients with ischaemic heart disease and acute coronary syndromes - a review of evidence and recommendations

Type 2 diabetes mellitus (T2DM) represents a major healthcare condition of the 21st century. It is characterised by persistently elevated blood glucose occurring as a result of peripheral insulin resistance and reduced insulin production which may lead to multiple long-term health conditions such as retinopathy, neuropathy, and nephropathy. The estimated number of individuals suffering from diabetes mellitus (DM) is expected to rise to 591 million by the year 2035 with 4.4 million in the United Kingdom (UK) alone, 90% of which is attributed to T2DM. Moreover, a significant proportion of individuals may have undetected diabetes mellitus, especially among those presenting with symptoms of ischaemic heart disease (IHD). This is particularly important in those individuals presenting with acute coronary syndromes (ACS) who are at the highest risk of complications and sudden cardiac death. Identifying abnormal levels of common biochemical markers of diabetes, such as capillary blood glucose or glycated haemoglobin (HbA1c) in these patients is important for early diagnosis, which will then allow for timely intervention to improve outcomes. However, a significant proportion of individuals who meet the criteria for the diagnosis of diabetes remain undiagnosed, representing missed opportunities for early intervention. This may result in a prolonged period of untreated hyperglycaemia, which can result resulting in significant further microvascular and macrovascular complications. There is an increased risk of IHD, heart failure, cerebrovascular accidents (CVA), and peripheral artery disease (PVD). These account accounting for 50% of deaths in patients with T2DM. Cardiovascular diseases in the context of diabetes particular represent a significant cause of morbidity and mortality with a two to three times higher risk of cardiovascular disease in individuals with T2DM than in those without the condition normo-glycaemia. In the United Kingdom UK alone, around 120 amputations, 770 CVA, 590 heart attacks, and more than 2300 presentations with heart failure per week are attributed to diabetes DM. with One 1 in six 6 hospital beds and around 10% of the healthcare budget may be being spent on managing diabetes DM or its complications. Therefore, it represents a significant burden on our healthcare system.</p

Acute kidney injury in patients presenting with acute coronary syndrome, with and without diabetes mellitus

IntroductionAcute kidney injury (AKI) remains an important complication associated with acute cardiovascular insult. It may be associated with increased hospital stay, morbidity and mortality. Diabetes mellitus (DM) results in chronic microvascular damage of the kidney and is a significant risk factor for the development of AKI. Assessing the prevalence of AKI in patients with acute coronary syndrome (ACS) as well as in the period following discharge, with and without DM, are important factors in early identification of high-risk individuals and timely initiation of appropriate therapies.PurposeTo assess the (i) incidence of AKI in all patients presenting with an ACS, and (ii) incidence of further AKI in the 12 months following successful discharge, based on the presence or absence of DM.</p

Reducing cardiovascular and renal outcomes via early sodium-glucose co-transporter-2 inhibitor therapy in patients with type 2 diabetes mellitus and acute coronary syndrome- A propensity score matched multi-model retrospective registry analysis

   Introduction: Sodium-glucose co-transporter inhibitors (SGLT2is) are indicated to reduce cardiovascular events in individuals with type 2 diabetes mellitus (T2DM) and stable atherosclerotic cardiovascular disease. However, due to lack of evidence, concerns of use in acute coronary syndromes (ACS) remain despite patients being at highest risk of further cardiovascular and renal events, where early SGLT2is may offer greater risk reduction in terms of these outcomes.  Purpose: To assess real world evidence of the impact of early SGLT2i therapy when prescribed at discharge, in comparison to those that receive it late i.e. post discharge and those that never receive it, in the reduction in major adverse cardiovascular events (MACE) and renal events in patients with T2DM presenting with ACS.</p

Reducing reno-cardiovascular risk and mortality though a specialised multi-disciplinary cardiodiabetic service approach for early optimisation of care among patients with diabetes mellitus and acute coronary syndrome

Introduction:Diabetes mellitus (DM) remains a prevalent condition worldwide and a significant risk factor for atherosclerotic cardiovascular disease. Recent evidence suggest 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, particularly in patients presenting with acute coronary syndrome (ACS). 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.Purpose:To assess the impact of a dedicated cardiodiabetic service on (i) screening and monitoring of patients for DM via a valid glycated haemoglobin (HbA1c) (ii) early optimisation of glucose lowering therapies with proven cardiovascular benefit and (iii) impact on reno-cardiovascular outcomes including all cause death and hospitalisations.</p