Diabetes mellitus (DM) is a common comorbidity among patients with acute coronary syndrome (ACS). The frequency with which physicians assess diabetic patients' glycemic control during an ACS hospitalization is not known and may represent an opportunity for quality improvement.

This study describes the proportion of diabetic patients who had an assessment of their glycemic control (HbA_1c) at the time of an ACS hospitalization. Secondary analyses examined characteristics associated with HbA_1c assessment and physicians' responses to poor glycemic control.

Among 968 enrolled patients with ACS, 235 (24%) had DM. HbA_1c values were known or obtained in 162 (69%) patients; 60% were poorly controlled (HbA_1c >7). Older patients were less likely to have an HbA_1c 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 HbA_1c, 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 HbA_1c, 42% with an HbA_1c of 7 to 9 and 69% of those with HbA_1c >9 had their diabetic regimen increased.

Almost one third of diabetic patients with ACS do not have HbA_1c 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.