# 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

## TL;DR

This study compares insulin plus oral diabetes drugs versus oral drugs alone in newly diagnosed diabetes patients with high blood sugar and heart issues, finding similar effectiveness after one year.

## Contribution

The study shows that oral anti-diabetic drugs alone are as effective as insulin plus oral drugs in reducing hbA1c in treatment-naïve patients with high hbA1c and ACS.

## Key findings

- No significant difference in hbA1c reduction between insulin + OAD and OAD-only groups after one year.
- Oral anti-diabetic drugs alone are a safe and effective alternative for patients unwilling to use insulin.
- No hyperglycaemic emergencies or cardiac readmissions were observed in either group.

## Abstract

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.

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.

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).

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.

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.