title: Diabetes-related knowledge, atherosclerotic risk factor control, and outcomes in acute coronary syndromes.
abstract: Patients who have diabetes mellitus have 2 times the incidence of an acute coronary syndrome (ACS) and 2 times the mortality rate after ACS compared with patients who do not have diabetes. Poor patient understanding of diabetes is believed to impede appropriate self-management, thus accelerating cardiovascular complications. We investigated the relation between patients' diabetes-related knowledge (DRK) and measurements of risk factor control and cardiac outcomes. Two hundred patients who had diabetes mellitus and ACS and were admitted to a university hospital were enrolled over a 9-month period. At enrollment, clinical and demographic data were recorded, and each patient completed a previously validated DRK assessment. Clinical outcomes data were obtained 6 months after enrollment. Years of education and DRK assessment score were moderately correlated (r = 0.496, p <0.0001). Glycosylated hemoglobin, low-density lipoprotein cholesterol, and body mass index showed no correlation with DRK assessment score (r = -0.045, -0.005, and 0.175, respectively), even after multivariable adjustment for differences in age, race, insulin requirement, duration of diabetes, and years of education. Rates of 6-month death (6.2% vs 9.7%) and death or myocardial infarction (15.5% vs 19.4%) were not significantly different between groups of patients stratified by DRK assessment scores (high vs low scoring groups). Thus, among patients who have diabetes and ACS, there is a moderate correlation between years of education and DRK. We found no correlation between DRK and measurements of risk factor control or 6-month clinical outcomes. New strategies must be developed to translate understanding of disease into better risk factor modification among patients who have diabetes and ACS.
authors.affiliation: Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Sánchez
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: Vic
authors.initials: V
authors.lastname: Hasselblad
authors.forename: Mark N
authors.initials: MN
authors.lastname: Feinglos
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
mesh_terms: D000368:Aged; D015992:Body Mass Index; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000517:prevention & control*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012648:Self Care
chemical_list: D006442:Glycated Hemoglobin