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Background: Acute coronary syndrome encompasses a range of clinical conditions resulting from sudden reduction in blood flow to the heart muscle, primarily due to the rupture of atherosclerotic plaques and subsequent thrombosis. It is an important global cause of death and also the major cause of morbidity and mortality in India. Abnormal glucose metabolism, significantly impacts cardiovascular health, exacerbating outcomes in acute coronary syndrome. The GRACE risk score, a tool for predicting ACS outcomes, may benefit from integrating continuous glucose monitoring (CGM) data. Aim: To investigate the relationship between glucose fluctuations and the GRACE risk score in ACS patients with abnormal glucose metabolism using continuous glucose monitoring Materials & Methods: In this observational study, 100 patients with ACS and abnormal glucose metabolism were monitored using CGM systems for 24 hours. The GRACE risk score was calculated for each patient. Correlations between the GRACE score, mean blood glucose levels, and glucose variability were analyzed. Results: A total of 100 participants were included in the study. The mean Grace risk score and mean 24 Hours Mean Blood Glucose (mmol/l) were 123 ± 28 and 7.8 ± 2.1. Majority of the participants were belonged to the intermidiate-risk group with 45%. Conclusion: The GRACE risk score is associated with glucose fluctuations in ACS patients with abnormal glucose metabolism. These findings suggest that glucose monitoring may enhance risk assessment and management strategies in this patient population. [ABSTRACT FROM AUTHOR]