Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Abbaszadeh, Shahin; Shafiee, Akbar; Bina, Payvand; Jalali, Arash; Sadeghian, Saeed; Karimi, Abbasali

doi:10.1097/hpc.0000000000000103

Cited by 8 publications

(9 citation statements)

References 24 publications

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“…Those receiving simultaneous insulin and oral hypoglycemic agents for the treatment of diabetes had relatively worse glycemic control, indicating a more aggressive nature of the disease. A previous study reported that diabetic patients on more intensive treatment regimens had higher mean hemoglobin A1c (HbA1C) levels [ 32 ]. Diabetes also seems more uncontrolled among men and younger individuals [ 5 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study

et al. 2022

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Background The prevalence of type 2 diabetes mellitus has increased in the past decades. We investigated the prevalence of diabetes and its awareness, treatment, and control among adult residents of Tehran. Methods We used the recruitment phase data of the Tehran Cohort study, enrolling a random sample of adult residents of Tehran aged ≥35 years. Diabetes was defined as self-report, current use of glucose-lowering medications, and/or fasting plasma glucose (FPG) ≥126mg/dl. Impaired fasting glucose (IFG) was defined as an FPG of 100-125mg/dl. Awareness was defined as diabetes self-report, treatment as receiving glucose-lowering medications, and glycemic control as FPG <126mg/dl. The age- and sex-weighted estimates were calculated using the 2016 national census. Logistic regression models were used to determine the factors associated with diabetes awareness, treatment, and control. Results A total of 8151 participants were included. Age- and sex-weighted prevalence of diabetes mellitus and IFG were 16.7% (95% CI: 15.1–18.4) and 25.1% (95% CI: 23.1–27.1), respectively. Diabetes was more prevalent in the eastern and central districts of Tehran. Advanced age (OR per 1-year increase: 1.026, 95% CI: 1.021-1.030), male sex (OR: 1.716, 95% CI: 1.543-1.909), higher BMI levels (OR for BMI ≥35 vs. <20 kg/m2: 4.852, 95% CI: 3.365-6.998), pre-existing hypertension (OR: 1.552, 95% CI: 1.378-1.747), dyslipidemia (OR: 1.692, 95% CI: 1.521-1.883), and chronic kidney disease (OR: 1.650, 95% CI: 1.019-2.673) were associated with an increased odds of diabetes mellitus. On the contrary, diabetes mellitus was less likely in current tobacco (OR: 0.872, 95% CI: 0.765-0.994) and alcohol users (OR: 0.836, 95% CI: 0.703-0.994) compared to non-users. Among diabetic individuals, 82.8% were aware of their condition, 71.9% received treatment, and 31.7% of treated patients had adequate glycemic control. Advanced age and pre-existing comorbidities, including hypertension and dyslipidemia, were associated with higher diabetes awareness and treatment. Furthermore, advanced age, higher levels of education, and female sex were determinants of better glycemic control among treated diabetic participants. Conclusion There is a high prevalence of diabetes and IFG among adult residents of Tehran. Additionally, more than two-thirds of treated diabetics living in Tehran remain uncontrolled.

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Section: Discussionmentioning

confidence: 99%

Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study

et al. 2022

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“…11 A meta-analysis of studies with a long follow-up period did show an increase in the incidence of AF that was proportional to the HbA1c. 12 However, a study of type 2 diabetic patients who had undergone cardiac surgery did not show an association between HbA1c and postoperative AF, 13 although peri-operative glycaemic fluctuations appear to increase the risk of post-operative AF. 14 In the ACCORD study, aggressive diabetes management with a target HbA1c of less than 6% failed to reduce the incidence of NAF compared to a target of 7.0% to 7.9%.…”

Section: Incidence and Frequency Of Atrial Fibrillation In The Typementioning

confidence: 99%

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Bell

Goncalves

2018

Diabetes Obesity Metabolism

102

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New-onset atrial fibrillation (NAF) is increased in the type 2 diabetic patient because of the presence of the metaboli syndrome and increased sympathetic activity. This results in inflammation, endothelial dysfunction and myocardial steatosis which, in turn, lead to atrial fibrosis and dilatation. The end result is the development of structural and electrical atrial remodeling. Drugs that lower insulin resistance, particularly pioglitazone, decrease the incidence of NAF while drugs that, through hypoglycaemia, stimulate the sympathetic nervous system, insulin and secretagogues, increase the incidence of NAF. Currently there is no evidence that GLP-1 agonists, SGLT2 inhibitors and DPP-4 inhibitors either accelerate or decelerate the development of NAF.

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“…The mean age ranged from 53 to 72 years. Among the fourteen articles, six [4,9,13,17,19,21] included diabetes or prediabetes patients, four [6][7][8]18] included subjects without known diabetes and four [5,14,15,20] studies reported both population with or without diabetes. Eight [4-9, 13, 18] studies examined the serum HbA1c status and AF, and 6 [14,15,17,[19][20][21] focused on POAF in patients undergoing CABG.…”

Section: Study Characteristics and Qualitymentioning

confidence: 99%

“…Six [14,15,17,[19][20][21] studies that included 1,335 cases and 7,616 patients were included in this analysis. Serum HbA1c (per 1% increase) was not associated with POAF incidence (RR: 1.00, 95% CI: 0.84-1.20, I 2 = 79%, P = 0.96) (Fig 4).…”

Section: Association Between Hba1c and Poaf In Patients Undergoing Cabgmentioning

confidence: 99%

Dose-response analysis between hemoglobin A1c and risk of atrial fibrillation in patients with and without known diabetes

Zhao

Liu²,

Chen

et al. 2020

PLoS ONE

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BackgroundThe relationship between serum hemoglobin A1c (HbA1c) and atrial fibrillation (AF) or postoperative AF (POAF) in coronary artery bypass (CABG) patients is still under debate. It is also unclear whether there is a dose-response relationship between circulating HbA1c and the risk of AF or POAF. Methods and resultsThe Cochrane Library, PubMed, and EMBASE databases were searched. A robust-error meta-regression method was used to summarize the shape of the dose-response relationship. The RR and 95%CI were using a random-effects model. In total, 14 studies were included, totaling 17,914 AF cases among 352,325 participants. The summary RR per 1% increase in HbA1c was 1.16 (95% CI: 1.07-1.27). In the subgroup analysis, the summary RR was 1.13 (95% CI: 1.08-1.19) or 1.12 (95% CI: 1.05-1.20) for patients with diabetes or without known diabetes, respectively. The nonlinear analysis showed a nonlinear (P nonlinear = 0.04) relationship between HbA1c and AF, with a significantly increased risk of AF if HbA1c was over 6.3%. However, HbA1c (per 1% increase) was not associated with POAF in patients with diabetes (RR: 1.13, P = 0.34) or without known diabetes (RR: 0.91, P = 0.37) among patients undergoing CABG. OPEN ACCESSCitation: Zhao H, Liu M, Chen Z, Mei K, Yu P, Xie L (2020) Dose-response analysis between hemoglobin A1c and risk of atrial fibrillation in patients with and without known diabetes. PLoS ONE 15(2): e0227262. https://doi.org/10.

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Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Abstract: Serum level of HbA1c could not be used as a predictor for the development of POAF.

Cited by 8 publications

References 24 publications

Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study

Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Dose-response analysis between hemoglobin A1c and risk of atrial fibrillation in patients with and without known diabetes

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