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

## TL;DR

A specialized cardiodiabetes service improved care and survival for patients with diabetes and heart attacks by better managing their glucose and kidney health.

## Contribution

The study introduces and evaluates a novel cardiodiabetes service for integrated management of diabetes and acute coronary syndrome.

## Key findings

- More patients in the post-intervention group had valid HbA1c measurements and were prescribed sodium-glucose co-transporter inhibitors.
- The post-intervention group showed significantly lower all-cause mortality and fewer acute kidney injury events.
- The cardiodiabetes service was associated with improved adherence to guideline-recommended therapies.

## Abstract

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.

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.

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.

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