Risk factor modification in diabetic patients following angiographic identification of multi-vessel disease

There is little information on whether identification of multi-vessel disease (MVD) in patients with diabetic mellitus (DM) affects risk factor management.From 1125 consecutively screened patients between June 2006 and March 2010, we examined 227 diabetic patients with MVD on coronary angiography. Diabetic control and cholesterol levels were assessed by glycated haemoglobin (HbA1c) and total cholesterol (TC) respectively which were evaluated at baseline and at 1-year follow-up. Patients were grouped by age into < 55(n = 33), 55-65(n = 75), 66-75(n = 75) and > 75(n = 44). Target levels were defined as HbA1c < 7% and TC < 4.0 mmol/L. Patients < 55 years had the highest HbA1c at 9.1[7.6-11.2]% with the lowest proportion of patients (n = 3; 11.1%) within target at baseline, while 66-75 years had the best HbA1c at 7.1[6.4-7.8]% with the highest proportion (n = 28, 45.2%) reaching target (p < 0.0001). At 1-year, the poorest HbA1c control was again observed in the age < 55 with fewer patients achieving target compared to the 66-75 age group (HbA1c: 8.5% vs 6.9%; % of patients at target: 20.7% vs 54.5%; p < 0.0001). Furthermore, the group < 55 years demonstrated the worst TC control at 1-year with a significant increase compared to the baseline TC (p = 0.01). Patients with a lower body mass index (BMI) were likely to have an improvement in HbA1c and reach target (p = 0.01). Paradoxically, patients who were current smokers demonstrated a beneficial effect on optimal TC control (29.2% vs 15.4%, p = 0.027).In younger diabetic patients, risk factor modification at 1-year was poor despite identification of MVD. Developing an effective education and monitoring programme to improve glycaemic control in this high risk group should be a priority.