CAMI-DM: Development and validation of a multi-algorithm model for in-hospital mortality risk prediction in diabetic patients with acute myocardial infarction - The China acute myocardial infarction r

Diabetes mellitus remains a major global public health challenge and is a leading contributor to morbidity and mortality worldwide. In 2019, diabetes was responsible for approximately 1.5 million deaths globally. The burden is particularly pronounced in Southeast Asia, where the International Diabetes Federation estimated that more than 34 million adults were living with diabetes, with projections rising to 55 million by 2035 []. In Malaysia, the National Health and Morbidity Survey (NHMS) 2023 reported an increasing trend in diabetes prevalence from 11.2% in 2011 to 15.6% in 2023. Among adults who were aware that they had diabetes, more than half (56%) were reported not to have good blood sugar control. In the NHMS 2023 technical report, raised blood glucose among those not known to have diabetes was defined as fasting blood sugar ≥7.0 mmol/L or random blood sugar ≥11.1 mmol/L during the field survey []. Diabetes self-management education is a cornerstone of long-term disease control. Educational interventions are commonly conceptualised within the knowledge-attitude-practice framework, whereby improved understanding of the disease influences attitudes, promotes behavioural change, and ultimately improves clinical outcomes [,]. Numerous studies have consistently demonstrated that structured diabetes education can improve self-care behaviours and glycaemic outcomes. However, in routine primary care practice, the delivery of comprehensive education is frequently constrained by limited consultation time, workforce shortages, and logistical barriers. These challenges were further amplified during the COVID-19 pandemic, highlighting the need for alternative models of care [,]. Technology-assisted and web-based educational interventions have been shown to improve diabetes-related outcomes, including modest reductions in glycosylated haemoglobin (HbA1C), while offering advantages in scalability, accessibility and cost-effectiveness [–]. However, evidence from Malaysian primary care settings remains limited, particularly among patients with persistently poor glycaemic control.