A Comparative Study on Young Patients of Uncontrolled and Well-controlled Diabetes Mellitus Presenting with Acute Myocardial Infarction

Background: Diabetes mellitus (DM) is a major risk factor for coronary artery disease (CAD) and acute myocardial infarction (AMI). Glycemic control can adjust the extent of coronary involvement in diabetic patients who present with acute myocardial infarction (AMI). This study aimed to compare the clinical and angiographic profile of young patients (≤40 Years) with Uncontrolled and Well-controlled diabetes mellitus (DM) presenting with acute myocardial infarction. Methods: This cross-sectional observational study was conducted at the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2025 to December 2025. Eighty diabetic patients presented with AMI, aged ≤40 years were recruited and equally divided into two groups: Uncontrolled DM (HbA1c ≥7.5%; n=40) and Well-controlled DM (HbA1c <7.5%; n=40). The socio-demographic characteristics, cardiovascular risk factors, clinical presentation, laboratory parameters, echocardiographic findings, and coronary angiographic profile were documented and compared between the two groups. Data were entered and analyzed using SPSS version 26.0. Results: The mean HbA1c was significantly higher in the uncontrolled DM group (9.2 ± 1.1 vs. 6.6 ± 0.5; p<0.001). The only cardiovascular risk factor that significantly differed between the two groups was dyslipidemia (75% vs. 50%; p=0.021). The uncontrolled DM group had a higher frequency of STEMI (75% vs. 62.5%), higher rates of atypical presentation (25% vs. 15%), delayed hospital arrival (62.5% vs. 45%), and a higher Killip class (II–IV: 40% vs. 25%). Laboratory parameters, such as LDL-C, triglycerides, and fasting glucose, were significantly higher in uncontrolled DM patients, whereas LVEF was lower in uncontrolled DM patients group. Angiographically, triple-vessel disease (35.0% vs. 15.0%; p=0.041), diffuse lesion pattern (65% vs. 45%; p=0.048), and severe CAD (45% vs. 25%; p=0.046) were significantly more common in uncontrolled DM patients. Uncontrolled DM, dyslipidemia, smoking, and hypertension were significantly associated with severe coronary artery disease. Conclusion: Uncontrolled diabetes mellitus is independently related to more extensive myocardial damage with worse haemodynamic status and more severe, diffuse, and multi-vessel coronary artery disease in young patients (≤40 Years) presenting with acute myocardial infarction. These results highlight the paramount significance of optimal glycemic control to reduce the burden and severity of CAD in young diabetic patients.