Acute Coronary Syndrome (ACS) represents a spectrum of cardiovascular conditions ranging from unstable angina to acute myocardial infarction, all of which require urgent medical attention. Objectives: The study's primary purpose is to find the prevalence of undiagnosed diabetes mellitus among patients presenting with acute coronary syndrome (ACS). Methods: This cross-sectional study was conducted in Khyber Teaching Hospital Peshawar from June 2021 to June 2022. Data was collected from 245 patients of ACS. Upon admission, demographic data, including age, gender, and medical history, were recorded. Laboratory investigations were performed to measure fasting blood glucose levels using standard techniques. Results: Data was collected from 245 ACS patients. The mean age of the patients was 48.7 ± 6.2 years. There were 170 male and 75 female patients. The prevalence of comorbidities was notable, with hypertension being the most common (49.0%), followed by dyslipidemia (40.8%), smoking (32.7%), and family history (24.5%). Serum creatinine levels were 1.2 ± 0.3 mg/dL, slightly elevated compared to the normal range of 0.6 - 1.1 mg/dL. Blood urea nitrogen levels averaged 20.5 ± 4.2 mg/dL, within the standard 7 - 20 mg/dL range. Fasting blood glucose levels were 120 ± 25 mg/dL, slightly above the normal range of 70 - 110 mg/dL. Hypertension was also associated with an increased risk of UDM, although not statistically significant, with an odds ratio of 1.8 (95% CI: 0.9 - 3.5). Conclusion: It is concluded that the prevalence of undiagnosed diabetes mellitus among patients presenting with acute coronary syndrome (ACS) is substantial, highlighting the importance of routine screening in this population. Early detection and management of diabetes in ACS patients are essential for optimizing cardiovascular outcomes and reducing the risk of adverse events.