Higher long-term visit-to-visit glycemic variability predicts new-onset atrial fibrillation in patients with diabetes mellitus

Abstract

Background Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Glycemic variability (GV) is associated with risk of micro- and macrovascular diseases. However, whether the GV can increase the risk of AF remains unknown. Methods The cohort study used a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 27,246 adult patients with T2DM were enrolled for analysis. Each individual was assessed to determine the coefficients of variability of fasting glucose (FGCV) and HbA1c variability score (HVS). The GV parameters were categorized into quartiles. Multivariate Cox regression models were employed to estimate the relationship between the GV parameters and the risk of AF, transient ischemic accident (TIA)/ischemic stroke and mortality in patients with T2DM. Results The incidence rates of AF and TIA/ischemic stroke were 21.31 and 13.71 per 1000 person-year respectively. The medium follow-up period was 70.7 months. In Cox regression model with full adjustment, the highest quartile of FGCV was not associated with increased risk of AF [Hazard ratio (HR): 1.12, 95% confidence interval (CI) 0.96–1.29, p = 0.148] or TIA/ischemic stroke (HR: 1.04, 95% CI 0.83–1.31, p = 0.736), but was associated with increased risk of total mortality (HR: 1.33, 95% CI 1.12–1.58, p < 0.001) and non-cardiac mortality (HR: 1.41, 95% CI 1.15–1.71, p < 0.001). The highest HVS was significantly associated with increased risk of AF (HR: 1.29, 95% CI 1.12–1.50, p < 0.001), total mortality (HR: 2.43, 95% CI 2.03–2.90, p < 0.001), cardiac mortality (HR: 1.50, 95% CI 1.06–2.14, p = 0.024) and non-cardiac mortality (HR: 2.80, 95% CI 2.28–3.44, p < 0.001) but was not associated with TIA/ischemic stroke (HR: 0.98, 95% CI 0.78–1.23, p = 0.846). The Kaplan–Meier analysis showed significantly higher risk of AF, cardiac and non-cardiac mortality according to the magnitude of GV (log-rank test, p < 0.001). Conclusions Our data demonstrate that high GV is independently associated with the development of new-onset AF in patients with T2DM. The benefit of maintaining stable glycemic levels to improve clinical outcomes warrants further studies.

In-hospital glycemic variability and all-cause mortality among patients hospitalized for acute heart failure

“…In addition, we showed that atrial fibrillation was more commonly detected during hospitalization in patients with high GV than those with low GV among the patients without previously reported AF. This finding is in line with the previous studies that revealed cardiac arrhythmias were common in insulin-treated patients with type 2 diabetes and are associated with GV [29], which was also independently associated with the development of new-onset atrial fibrillation in these diabetic patients [30].…”

Prediabetes as a risk factor for new-onset atrial fibrillation: the propensity-score matching cohort analyzed using the Cox regression model coupled with the random survival forest

“…We conducted a longitudinal retrospective cohort study using the electronic health records (EHRs) of Taiwanese individuals aged 45 years or older who received care at a tertiary medical center between January 1, 2014 and December 31, 2019. The EHRs were obtained from the National Taiwan University Hospital Integrated Medical Database (NTUH-iMD) [ 20 , 21 ], which collects data from the Taipei Main Hospital and branches in at least four counties in Taiwan. EHRs have been digitized and are available online since 2006 and include information on patients' demographics, diagnoses, medical orders, laboratory results, interventions, medications, and examinations.…”

Features of development, the possibility of prevention and treatment of atrial fibrillation in patients with diabetes mellitus

“…по-видимому, более благоприятен стабильный контроль гликемии при сд. на это косвенно указывают результаты когортного исследования у 27 246 пациентов с сд 2 типа, показавшего, что долгосрочная вариабельность гликемии от визита к визиту была независимо связана с развитием впервые возникшей фп [18].…”