Assessment of and physician response to glycemic control in diabetic patients presenting with an acute coronary syndrome

Background Diabetes mellitus (DM) is a common comorbidity among patients with acute coronary syndrome (ACS). The frequency with which physicians assess diabetic patientsʹ glycemic control during an ACS hospitalization is not known and may represent an opportunity for quality improvement. Methods This study describes the proportion of diabetic patients who had an assessment of their glycemic control (HbA1c) at the time of an ACS hospitalization. Secondary analyses examined characteristics associated with HbA1c assessment and physiciansʹ responses to poor glycemic control. Results Among 968 enrolled patients with ACS, 235 (24%) had DM. HbA1c values were known or obtained in 162 (69%) patients; 60% were poorly controlled (HbA1c >7). Older patients were less likely to have an HbA1c assessment (relative risk [RR] = 0.81 [95% CI 0.64-1.01] for patients 60-69 years and RR = 0.71 [95% CI 0.58-0.88] for those ≥70 years compared to patients <60 years, P = .004). Among patients without an HbA1c, only consultation by an endocrinologist was independently associated with obtaining a subsequent assessment (RR 1.60, 95% CI 1.33-1.92, P < .001). Among those with an elevated HbA1c, 42% with an HbA1c of 7 to 9 and 69% of those with HbA1c >9 had their diabetic regimen increased. Conclusions Almost one third of diabetic patients with ACS do not have HbA1c assessment at discharge; particularly older patients and those not evaluated by an endocrinologist. Although >60% of those assessed had poor control, many did not have adjustments of their diabetic therapy. Assessment of diabetes represents an opportunity to improve the quality of care for diabetic patients with ACS.