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Despite medical advances, individuals with diabetes have a 50% greater long-term mortality compared with those without. Further research to understand the determinants of this excess risk are important for public health, given the predicted rise in global diabetes prevalence.

ObjectiveTo explore the relative association of admission blood glucose levels and antecedent diabetes on early and long-term survival in a contemporary UK population of patients with ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).DesignRetrospective cohort study based on the Myocardial Ischaemia National Audit Project dataset.SettingTertiary care centre.Participants4111 (20.3% known diabetes) consecutive patients admitted with acute myocardial infarction (58.3% STEMI) between October 2002 and September 2008.Primary and secondary outcome measuresAll-cause mortality at 30 days and 1 year. The relative association of admission blood glucose and of antecedent diabetes with mortality was assessed using multivariate Cox regression analysis. Furthermore, we compared these relationships in patients with STEMI to those with NSTEMI.ResultsBy 30 days and 1 year, 409 (9.9%) and 677 (16.5%) of patients died. After adjusting for covariates, diabetes did not show independent association with mortality at any time point, in the entire cohort (HR 30 days 0.93 (95% CI 0.63 to 1.38); 1 year 1.00 (0.77 to 1.30)) or in subgroups of STEMI (HR 30 days 1.03 (0.65 to 1.64); 1 year 1.08 (0.77 to 1.51)) and NSTEMI (HR 30 days 0.62 (0.26 to 1.50); 1 year 0.87 (0.56 to 1.36)). In contrast, after adjusting for covariates, admission glucose showed robust and independent association with mortality in the entire cohort (HR: 30 days 1.07 (1.04 to 1.10); 1 year 1.05 (1.03 to 1.08)), and in the subgroup of STEMI (30 days 1.07 (1.03 to 1.10); 1 year 1.07 (1.04 to 1.10)), and NSTEMI (HR 30 days 1.07 (1.00 to 1.14); 1 year 1.02 (0.97 to 1.06)).ConclusionsAdmission glucose is strongly associated with mortality in all presentations of acute myocardial infarction (AMI), irrespective of established diabetes diagnosis. The increased risk is maintained up to 1 year. Future studies are required to assess the impact of active management of elevated blood glucose in improving mortality in individuals admitted with AMI.

T he Alphabet Strategy is a mnemonic-based approach to assist commitment to important aspects of diabetes care: Advice; Blood pressure lowering; Cholesterol and creatinine control; Diabetes control; Eye examination; Foot examination; and use of Guardian drugs. This strategy reported high standards of care of patients with type 2 diabetes. This study assesses the impact of the Alphabet Strategy on diabetes management in young adults with type 1 diabetes and compared data with those of a recently published multicentre study. Results were analysed using the chi-square test and Student's t-test.Data were collected retrospectively from 68 patients with type 1 diabetes aged 16-25 years attending the George Eliot Hospital (GEH) adolescent diabetes clinic and who were being managed as per The Alphabet Strategy.Standards of diabetes care in the GEH clinic were better than those reported in the multicentre study. GEH versus multicentre study: clinic non-attendance 12% vs. 24.6%: mean HbA 1C % 8.4 vs. 9.5, p<0.001: screening rates; hypertension 100% vs. 88%, p<0.05; nephropathy 80% vs. 56%, p<0.01; retinopathy 98% in GEH clinic: prevalence of complications; nephropathy 5% vs. 21%, p<0.02; retinopathy 24% vs. 28%, not significant.In conclusion, we found regular clinic visits and separate adolescent clinics improve glycaemic control. The Alphabet Strategy may be considered an effective approach in monitoring/screening and attaining targets in young adults with type 1 diabetes. Br J Diabetes Vasc Dis 2006;6:168-70