Dauriz M, Morici N, Gonzini L, et al. - Data (n = 28,225 participants) from five nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units, were investigated by researchers to analyze time trends of management and mortality of acute coronary syndrome patients with correlated diabetes mellitus. A total of 8,521 had diabetes, and in comparison with patients without diabetes, they were older and had significantly greater rates of prior myocardial infarction and comorbidities. The prevalence of diabetes and comorbidities rose over time. In patients with diabetes, cardiogenic shock rates were greater vs those without diabetes, and reduced significantly over time in patients without diabetes. Among patients with and without diabetes, revascularization rates rose over time—but with persistently lower rates among patients with diabetes. In patients with diabetes, all-cause in-hospital mortality was greater and reduced more consistently in patients without diabetes. Of both cardiogenic shock and mortality, diabetes persisted to be an independent predictor. Thus, patients with diabetes had threefold higher rates of cardiogenic shock and lower revascularization rates vs patients without diabetes, irrespective of important mortality declines seen over 15 years in acute coronary syndromes. These conclusions may help to illuminate the consistent greater mortality rates among patients with diabetes and acute coronary syndromes.