Introduction: The National Institute of Health and Care Excellence (NICE) 2022 guidelines recommend Sodium-Glucose Cotransporter Inhibitors (SGLT2-i) in diabetic patients with established coronary artery disease. The European Society of Cardiology (2023) and American College of Cardiology (2025) similarly emphasize glucagon-like peptide receptor agonists (GLP-1RA) and/or SGLT2-i in this population.

Aim: To assess whether patients admitted with acute coronary syndrome (ACS) are screened for diabetes mellitus and, if significant CAD is present, prescribed SGLT2-i irrespective of HbA1c targets.

Methodology: An observational retrospective audit was conducted on patients undergoing coronary angiogram or percutaneous coronary intervention between November 2024 and January 2025. Inclusion criteria were patients with evidence of CAD on angiography. Data were collected from electronic records and analyzed using Microsoft Excel.

Results: Among 149 patients, 66% (n=99) were screened for diabetes. Of those screened, 30.3% (n=30) had diabetic-range HbA1c. Overall, 30% (n≈45) of the total study population were diabetic, yet only 42% (n=17) of them were prescribed SGLT2-i. The remaining 58% (n=26) did not receive SGLT2-i, either during admission or at discharge.

Conclusions: In patients with diabetes and CAD, guideline-directed treatment with SGLT2-i and/or GLP-1RA is recommended to reduce cardiovascular risk, independent of glycemic control. This audit highlights gaps in both diabetes screening and prescribing practice.

Recommendations: All patients with established CAD should be screened for diabetes. Where HbA1c confirms diabetes and no contraindication exists, SGLT2-i should be initiated as guideline-directed therapy.