Impact of type 2 diabetes mellitus on the evolution of acute myocardial infarction

Abstract

Background. Type 2 diabetes mellitus (T2DM) triples the risk of acute myocardial infarction (AMI) and raises mortality by 30–50%. A global prevalence of 9.3% boosts AMI incidence and severity, demanding sustained, individualized therapy and ongoing monitoring to ensure optimal long-term clinical outcomes. Objective(s). Highlighting the impact of type 2 diabetes mellitus on the clinical course and prognosis of acute myocardial infarction to underpin tailored therapy strategies and effective secondary prevention. Materials and methods. A comprehensive synthesis of peer-reviewed literature published from 2020 to 2025 was conducted by searching PubMed, Scopus, Medscape, ScienceDirect and UpToDate for the terms “type 2 diabetes mellitus”, “acute myocardial infarction” and “cardiovascular complications”. The review delineates how T2DM precipitates AMI and worsens post-AMI prognosis. Results. Type 2 diabetes mellitus (T2DM) worsens acute myocardial infarction (AMI), generating atypical clinical presentations in 36% of cases versus 24% in non-diabetics. Antero-septal STEMI was registered in 52% versus 41%, while angiographic coronary thrombosis occurred in 29% against 14%. Cardiogenic shock developed in 6.1% versus 3.2%. Mean left-ventricular ejection fraction dropped to 43 ± 8% in diabetics versus 49 ± 7%. Early mortality doubled (41% vs 20%; p<0.05). At 12 months, major cardiovascular events (recurrent myocardial infarction) reached 12% versus 5%, confirming the harmful impact of chronic hyperglycemia on coronary lesions. Conclusion(s). Analysis confirms the hypothesis: type 2 diabetes aggravates AMI. Strict control of fasting glucose < 7.2 mmol/L, HbA1c ≤ 7 %, BP < 130/80 mmHg, LDL-c < 1.4 mmol/L, maintaining normal weight, and continuous cardio-metabolic surveillance before and after AMI lower recurrence and mortality.