Insulin-treated vs non-insulin-treated patients in type II diabetes mellitus: how the therapy influence the CV outcome in patients with acute coronary syndrome?

Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) are at a significantly higher risk of adverse cardiovascular (CV) outcomes compared to those without DM. Previous studies have suggested that insulin therapy in Type 2 DM is associated with poorer outcomes in ACS patients.

To evaluate whether insulin-treated patients with Type 2 DM who experience ACS have worse CV outcomes in the current era of advanced therapies for glycemic control.

This observational, retrospective study included Type 2 DM patients admitted with ACS and undergoing percutaneous coronary intervention (PCI) between January 2020 and December 2021, with a minimum follow-up of 23 months. Demographic characteristics, cardiovascular risk factors, ACS type, and treatment modalities were collected. The primary outcome was a composite of cardiovascular hospitalization, unplanned PCI, or CV death. Multivariate logistic regression was used to identify independent predictors of the outcome.

A total of 161 patients were included, of whom 27 (16.8%) were on insulin therapy. The insulin-treated group was predominantly male (51.9%) with a mean age of 66.2 ± 10.0 years. No significant differences were observed between the two groups in terms of baseline characteristics except for the primary outcome. Patients on insulin therapy experienced a higher rate of adverse CV events (37.0% vs. 14.9%, p=0.007). Multivariate analysis confirmed insulin therapy as an independent predictor of adverse CV outcomes (OR=3.33, 95% CI 1.29-8.61, p=0.013).