Improvement in Glycemic Control After Left Ventricular Assist Device Implantation in Advanced Heart Failure Patients With Diabetes Mellitus

Abstract

Left ventricular assist devices (LVADs) have been shown to improve outcomes in advanced heart failure (HF). We hypothesized that LVADs improve glycemic control in HF patients with diabetes mellitus (DM). During a 6 year time period, 202 patients underwent mechanical circulatory support. Of these, 50 patients with DM were included. Data were collected within 2 months before LVAD implantation and at 5.6 ± 1.1 months post-LVAD implant. There was no significant difference in body mass index, hemoglobin, hematocrit, and renal function pre-LVAD and post-LVAD. Fasting blood glucose improved from 136 ± 35 to 108 ± 29 mg/dl post-LVAD (p < 0.001). In 18 patients taking insulin only, daily insulin dose decreased from 43 ± 37 to 29 ± 24 units (p = 0.02). Of the 17 patients taking oral hypoglycemic agents, four did not require antidiabetic medications, six continued the same dose, two required higher doses, and five patients were switched to insulin post-LVAD. In a subset of 22 patients with available data, hemoglobin A1c improved significantly post-LVAD (p < 0.001). C-reactive protein in a subset of 18 patients decreased post-LVAD (p = 0.059). In conclusion, diabetic patients with advanced HF appear to have significant improvement in glycemic control and require less antidiabetic medications post-LVAD.

Influence of Diabetes Mellitus on Outcomes in Patients After Left Ventricular Assist Device Implantation

“…We assessed pre-LVAD hemoglobin A1c and found no significant difference in survival in diabetics with controlled diabetes (baseline HbA1c < 7%) compared with patients with poorly controlled diabetes (baseline HbA1c ≥ 7.0%). We and others have demonstrated improved glycemic control after LVAD implant in diabetic patients [13–16]. The current study suggests that despite improved glycemic control, mortality remains high in diabetic LVAD patients.…”

Left ventricular assist device implantation improves glycaemic control: a systematic review and meta‐analysis

“…(Table 1). 6,[16][17][18][19][20][21][22][23][24][25][26][27] All studies were single-centre, retrospective observational investigations that utilized a pre-post design and were published as full-text articles, except one that is only available in abstract form. 16 Sample sizes ranged from 11 to 139 with durations of follow-up ranging from 126 days to 12 months.…”

“…Six studies 6,21,22,[25][26][27] reported changes in fasting blood glucose before and after LVAD implantation (Table S2). Pooled analysis showed a significant 24.4 mg/dL reduction at followup (95% CI À33.4 to À15.5) and little statistical heterogeneity (I 2 = 7%, Cochrane P = 0.37) ( Figure 3).…”

“…Pooled analysis showed a significant 24.4 mg/dL reduction at followup (95% CI À33.4 to À15.5) and little statistical heterogeneity (I 2 = 7%, Cochrane P = 0.37) ( Figure 3). Eight studies 6,[16][17][18][21][22][23][24] reported insulin requirements, showing patients required 18.8 (95% CI À28.8 to À8.7; I 2 = 66%, Cochrane P < 0.01) fewer units of insulin per day following LVAD implantation ( Figure 4). Changes in BMI (kilogram per square metre) were reported in seven studies, 6,16-18,21-23 which revealed no significant difference after LVAD implantation (MD 0.09, 95% CI À1.24 to 1.42; I 2 = 43%, Cochrane P = 0.11) ( Figure 5).…”

“…However, significant reductions in post-LVAD serum creatinine (milligrams per decilitre) levels were seen in a pooled analysis of seven studies (MD À0.20, 95% CI À0.35 to À0.06; I 2 = 25%, Cochrane P = 0.24) (Figure 6) 6,17,22,23,[25][26][27]. Changes in BMI (kilogram per square metre) were reported in seven studies, 6,16-18,21-23 which revealed no significant difference after LVAD implantation (MD 0.09, 95% CI À1.24 to 1.42; I 2 = 43%, Cochrane P = 0.11) (Figure 5).…”