Prevalence and Predictors of Undiagnosed Diabetes Mellitus among Patients Presenting With Acute ST-Elevation Myocardial Infarction in Karachi, Pakistan

Abstract

Objectives: To determine the prevalence of probable undiagnosed diabetes mellitus (UDM) among patients presenting with Acute ST-Elevation Myocardial Infarction (STEMI) at a major tertiary cardiac care facility in Karachi, Pakistan. Methodology: A cross-sectional study was conducted on 140 consecutive STEMI admissions at the National Institute of Cardiovascular Diseases (NICVD) between April and October 2022. Patients with missing data, previously diagnosed diabetes, prior myocardial infarction, chronic kidney disease, anemia, recent blood transfusion, or pregnancy were excluded. Random blood sugar (RBS) and admission HbA1c were measured. UDM was defined as HbA1c ≥6.5% based on ADA criteria. Associations were assessed using Chi-square or Fisher’s Exact Test, and multivariable logistic regression was used to identify independent predictors. Results: Among 140 patients, 88.6% were male and 11.4% were female. Overall, 44.3% met criteria for UDM. Elevated RBS was common, with 75.7% presenting with RBS ≥200 mg/dL. In unadjusted analyses, female gender (p=0.042), hypertension (p=0.029), and RBS ≥200 mg/dL (p<0.001) were significantly associated with UDM. Logistic regression identified female gender (OR 4.56, 95% CI 1.26–16.5), smoking (OR 2.53, 95% CI 1.11–5.77), and RBS ≥200 mg/dL (OR 7.32, 95% CI 2.45–21.87) as independent predictors. Conclusion: Nearly half of STEMI patients had previously unrecognized diabetes. Routine HbA1c and point-of-care glucose screening in emergency cardiac settings could improve early detection and timely management of latent diabetes in high-risk populations.