Background: Diabetes mellitus is strongly linked with accelerated atherosclerosis, subclinical myocardial injury, and a high burden of cardiovascular complications. Individuals with Type 2 Diabetes Mellitus frequently present with atypical or silent ischemic symptoms, making timely diagnosis challenging and increasing the risk of delayed treatment. Electrocardiography and cardiac biomarkers offer valuable insight for early detection of myocardial stress, particularly in patients with poor metabolic control. Determining the relationship between glycemic status, ECG abnormalities, and troponin elevation is therefore essential for effective cardiovascular risk assessment in this high-risk population. Objective: This study aimed to determine the association between glycemic control (HbA1c), ECG abnormalities, and elevated troponin I levels in diabetic patients presenting with chest discomfort, and to evaluate whether poor glycemic regulation predicts myocardial ischemia or injury identifiable through ECG or cardiac biomarkers. Methods: A six-month cross-sectional analytical study was conducted in the Cardiology Department of CMARTH, enrolling 255 adults (≥18 years) with confirmed Type 2 Diabetes Mellitus presenting with chest pain. Patients with CKD stage ≥3, structural heart disease, non-diabetic status, or incomplete records were excluded. Data collection included 12-lead ECG interpreted independently by two physicians, HbA1c measurement categorized according to ADA criteria, and serum troponin I testing. Statistical analysis using SPSS version 23 involved descriptive statistics, Pearson correlation, and cross-tabulation to evaluate associations between glycemic status, ECG abnormalities, and troponin levels. Results: The mean age of participants was 63.03 ± 11.24 years, with female predominance (69.01%). ST depression was present in 26.7%, ST elevation in 22%, T-wave inversion in 24.3%, arrhythmias in 11.8%, and non-specific changes in 15.3%. Most patients (73.72%) had uncontrolled diabetes (HbA1c ≥ 6.5%). Elevated troponin I levels showed a significant positive correlation with poor glycemic control, indicating increased myocardial injury in metabolically uncontrolled individuals. Conclusion: Poor glycemic control was significantly associated with both elevated troponin I and ECG abnormalities in diabetic patients with chest pain, underscoring the need for routine cardiac screening and strict metabolic management to reduce cardiovascular complications.