UNDIAGNOSED DIABETES MELLITUS IN ACUTE CORONARY SYNDROME (ACS) PATIENTS
Main Article Content
Keywords
Undiagnosed diabetes, acute coronary syndrome, HbA1c, cardiovascular risk, Pakistan.
Abstract
Introduction: Undiagnosed diabetes mellitus is a common but often overlooked condition among patients presenting with acute coronary syndrome (ACS), significantly impacting clinical outcomes and recovery.
Objective: To determine the prevalence of undiagnosed diabetes in ACS patients and evaluate its impact on presentation and short-term prognosis.
Materials and Methods: A cross-sectional study was conducted at Department of Medicine, Mayo Hospital Lahore, Pakistan, from October, 2024 to March, 2025. ACS patients without prior diabetes history were screened using HbA1c, fasting glucose, and OGTT. Clinical and biochemical profiles were recorded and analyzed.
Results: Among 237 ACS patients, 92 (38.8%) were newly diagnosed with diabetes. These patients exhibited higher BMI, hypertension, and dyslipidemia. Atypical ACS presentations and elevated troponin-I levels were more common among them, indicating more severe myocardial injury.
Conclusion: Undiagnosed diabetes is highly prevalent in ACS patients and associated with worse clinical parameters. Routine diabetes screening in ACS admissions is essential for timely diagnosis and improved outcomes.
References
2- Drobek N, Sowa P, Jankowski P, Haberka M, Gąsior Z, Kosior D, Czarnecka D, Pająk A, Szostak-Janiak K, Krzykwa A, Setny M. Undiagnosed diabetes and prediabetes in patients with chronic coronary syndromes—An alarming public health issue. Journal of Clinical Medicine. 2021 May 5;10(9):1981.
3- Shah MU, Roebuck A, Srinivasan B, Ward JK, Squires PE, Hills CE, Lee K. Diagnosis and management of type 2 diabetes mellitus in patients with ischaemic heart disease and acute coronary syndromes-a review of evidence and recommendations. Frontiers in Endocrinology. 2025 Jan 22;15:1499681.
4- Liu W, Li Z, Xing S, Xu Y. Effect of Admission Hyperglycemia on Short‐Term Prognosis of Patients with Non‐ST Elevation Acute Coronary Syndrome without Diabetes Mellitus. Journal of Diabetes Research. 2021;2021(1):1321289.
5- Johnson CA, Pitta NC, Dessotte CA, Dantas RA, Rossi LA. Knowledge, attitudes, and beliefs about acute coronary syndrome among patients with type 2 diabetes. Revista Latino-Americana de Enfermagem. 2021 Nov 19;29:e3503.
6- Fanta K, Daba FB, Asefa ET, Chelkeba L, Melaku T. Prevalence and impact of metabolic syndrome on short-term prognosis in patients with acute coronary syndrome: Prospective cohort study. Diabetes, Metabolic Syndrome and Obesity. 2021 Jul 15:3253-62.
7- Khan FR, Ali J, Ullah R, Hassan Z, Khattak S, Lakhta G, Gul N, Khattak SU, Gul NZ. Relationship between high glycated hemoglobin and severity of coronary artery disease in type II diabetic patients hospitalized with acute coronary syndrome. Cureus. 2021 Mar 6;13(3).
8- Gadager BB, Tang LH, Ravn MB, Doherty P, Harrison A, Christensen J, Taylor RS, Zwisler AD, Maribo T. Benefits of cardiac rehabilitation following acute coronary syndrome for patients with and without diabetes: a systematic review and meta-analysis. BMC Cardiovascular Disorders. 2022 Jun 27;22(1):295.
9- Demisse L, Alemayehu B, Addissie A, Azazh A, Gary R. Knowledge, attitudes and beliefs about acute coronary syndrome among patients diagnosed with acute coronary syndrome, Addis Ababa, Ethiopia. BMC Cardiovascular Disorders. 2022 Oct 14;22(1):444.
10- Manistamara H, Sella YO, Apriliawan S, Lukitasari M, Rohman MS. Chest pain symptoms differences between diabetes mellitus and non-diabetes mellitus patients with acute coronary syndrome: a pilot study. Journal of Public Health Research. 2021 Apr 14;10(2):jphr-2021.
11- Muneeb M, Khan AH, Niazi AK, Khan MU, Chatha ZJ, Kazmi T, Shahid N, Chatha Z. Patterns of dyslipidemia among acute coronary syndrome (ACS) patients at a tertiary care hospital in Lahore, Pakistan. Cureus. 2022 Dec 10;14(12).
12- Jarrah M, Alrabadi N, Al-Nusair N, Alzoubi KH, Mhaidat Q, Al-Najar M, Hammoudeh A. Clinical outcomes and cardiovascular-related events in young diabetic patients with acute coronary syndrome. Vascular Health and Risk Management. 2022 Feb 17:55-60.
13- Ahmed S, Abbas U, Khowaja S, Shah SA, Hashim M, Hulio AA. Association of diabetes mellitus and hypertension with angiographic profile of acute coronary syndrome patients. Pakistan Journal of Medical & Health Sciences. 2022 May 26;16(05):153-.
14- Noreldin AK, Elameer DA, Khalil HA. Impact of Prediabetes on Acute Coronary Syndrome in Sohag University Hospital. SVU-International Journal of Medical Sciences. 2024 Jan 1;7(1):26-37.
15- Jiao Y, Wang J, Yang X, Shen M, Xue H, Guo J, Dong W, Chen Y, Xi Q, Fu Z. Evaluation of the prognostic ability of serum uric acid for elderly acute coronary syndrome patients with diabetes mellitus: a prospective cohort study. Journal of Zhejiang University-SCIENCE B. 2021 Oct;22(10):856-65.
16- Zywicki V, Capozza P, Caravelli P, Del Prato S, De Caterina R. Glucose tolerance and markers of myocardial injury after an acute coronary syndrome: predictive role of the 1-h plus 2-h plasma glucose at the oral glucose tolerance test. Cardiovascular Diabetology. 2022 Aug 8;21(1):152.
17- Wang M, Su W, Cao N, Chen H, Li H. Prognostic implication of stress hyperglycemia in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Cardiovascular diabetology. 2023 Mar 21;22(1):63.
18- Wang M, Zhou L, Su W, Dang W, Li H, Chen H. Independent and joint associations between the triglyceride-glucose index and NT-proBNP with the risk of adverse cardiovascular events in patients with diabetes and acute coronary syndrome: a prospective cohort study. Cardiovascular Diabetology. 2023 Jun 26;22(1):149.
19- Gao Y, Li Y, Chen X, Wu C, Guo Z, Bai G, Liu T, Li G. The systemic inflammation index predicts poor clinical prognosis in patients with initially diagnosed acute coronary syndrome undergoing primary coronary angiography. Journal of Inflammation Research. 2023 Dec 31:5205-19.
20- Ali U, Ashraf A, Ahmad A. DIABETIC PATIENTS AND THEIR PRESENTATION IN ACUTE CORONARY SYNDROME WITH OUTCOMES: DOES GENDER PLAY ROLE?. Pakistan Heart Journal. 2022 Mar 25;55(1):79-82.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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Talal Safdar
Assistant Professor of Medicine, Fauji Foundation Hospital Rawalpindi, Pakistan
Syed Meerab Javed
MBBS, FCPS (Med), Consultant Internist, Department of Medicine, King Salman Armed Forces Hospital, Tabuk, Saudia Arabia
Chander Parkash
Assistant Professor Adult Cardiology, Sindh Institute of Cardiovascular Diseases, Pakistan
Niaz Ahmed
Professor, Department Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi and Sindh Government Lyari General Hospital Karachi, Pakistan
Muhammad Mohsin Sial
House Officer, Department of Internal Medicine, Mayo Hospital Lahore, Pakistan
Sajjad ul Hasan
Assistant Professor, Department of Community Medicine, Amna Inayat Medical College, Sheikhupura, Punjab, Pakistan