Diabetics Receive Inferior Coronary Syndrome Care

Diabetics appear less likely to receive guideline-adherent care for non-ST-segment elevation acute coronary syndromes (ACS), than patients without the condition.

Lead investigator Dr. Gerard X. Brogan stated that, "there is a substantial body of research demonstrating that the diabetic patient is at greater risk than non-diabetics for cardiac disease and its complications and that they may benefit to a greater degree than non-diabetics to available treatments.

"However," he added, "in our study comparing the care of all patients coming to the hospital for possible heart attack or chest pain, the diabetic patients were less likely to receive the currently recommended treatments as specified in the American Heart Association — American College of Cardiology clinical guidelines."

It is important that all ACS patients, and particularly diabetic patients, receive evidence-based treatment, Dr. Brogan of North Shore University Hospital, Plainview, New York and colleagues note.

To evaluate compliance with guidelines, the researchers studied data for more than 46,000 non-ST-segment elevation ACS patients who received care at 413 US hospitals.

Insulin-treated diabetics were less likely than non-diabetics to receive aspirin, beta blockers, heparin and glycoprotein IIb/IIIa inhibitors. Non-diabetics and type 2 diabetics received similar treatment.

After adjustment for differences in clinical characteristics, insulin-treated diabetics were significantly less likely than non-diabetics to receive cardiac catheterization with 24 hours or percutaneous coronary intervention.

In addition, both classes of diabetics were about 1.35 times as likely to undergo coronary artery bypass grafting than were non-diabetics. In-hospital mortality in insulin-treated diabetics was 6.8%. For type 2 diabetics, it was 5.4% and for non-diabetics, it was 4.4%.

The researchers call for more guideline-based management, pointing out that despite the higher mortality risk in diabetics, physicians adhere less often to recommendations when treating these patients, particularly those on insulin.

Diabetes Care 2006;29:9-14.