Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

Introduction. Diabetes is associated with a lower quality of life (QoL). Insulin therapy is perceived as an additional factor affecting QoL. The objective of this study, using standardized tools, was to evaluate to what extent insulin treatment has an effect on QoL in diabetes. Materials and method. 60 diabetic patients treated with insulin and 90 with oral drugs, all aged over 30, were included into the study. To assess the QoL of patients, SF-36 v.2 and WHOQOL-BREF questionnaires were used. In addition, demographic data were collected. Results. Insulin treated patients had a significantly lower Mental Component Score in SF-36 v.2 questionnaire. No significant differences between the two groups were found in the components of physical domain of SF-36 v.2 and in four domains of WHOQOL-BREF questionnaires. Insulin therapy was significantly associated with lower educational level. The strongest association with QoL in both questionnaires was found for professional activity and age. Conclusions. The results of this study indicate the need for psychological support for patients with diabetes treated with insulin to improve their mental coping. Diabetic patients should also be advised to continue their professional activity for as long as possible due to its important role in maintaining QoL.