A non-interventional, multicenter, observational study to provide real-world evidence on the diagnosis of chronic...

Long-standing type 2 diabetes mellitus (DM) increases the risk of chronic coronary syndrome (CCS). We estimated the prevalence of undiagnosed CCS during routine outpatient care and described diagnostic testing strategies.

This multicenter observational study was conducted in eight diabetes and cardiology outpatient clinics in Greece. Adults with DM ≥ 10 years and suspected ischemia [angina equivalents and/or ischemic electrocardiographic (ECG) abnormalities] without known CCS underwent joint diabetologist-cardiologist evaluation and appropriate non-invasive and/or invasive testing at the physician's discretion.

Overall, 110 people with type 2 DM (mean age 65.4 years; 47.3% women; mean DM duration 21.3 years) were evaluated. CCS was diagnosed in 15 individuals (13.6%). No patient with CCS reported typical or atypical angina; presentations were mainly angina equivalents, most commonly fatigue (66.7%) and dyspnea (58.3%). Ischemic ECG abnormalities were present in 6/15 (40.0%), including repolarization or conduction changes. Initial tests varied: exercise ECG (33.6%), SPECT/PET (32.7%), and stress echocardiography (28.2%).

This study highlights the diagnostic complexity of detecting CCS in individuals with type 2 DM, particularly due to the prevalence of non-classical symptoms. The findings underscore the importance of a personalized diagnostic approach and multidisciplinary collaboration between diabetologists and cardiologists to improve cardiovascular risk stratification.