title: Improved diabetic control in advanced heart failure patients treated with left ventricular assist devices.
abstract: OBJECTIVE
  Left ventricular assist devices (LVADs) are increasingly used as therapeutic options for patients with advanced congestive heart failure (CHF), many of whom suffer from diabetes mellitus (DM). The aim of this study was to evaluate the effect of restoration of normal cardiac output using LVAD support on diabetes control in patients with advanced CHF.
  
  
  RESULTS
  A retrospective chart review of all clinic patients supported with long-term LVADs between July 2008 and July 2009 at Columbia University Medical Center was performed. Patients with DM diagnosed prior to device implantation were included in this analysis. Clinical and laboratory data within 1 month preceding and 6 months following LVAD implantation were collected. Of 43 LVAD patients followed in our clinic during the study period, 15 had a diagnosis of DM. Thirteen of the 15 patients were male, mean age was 63 ± 11 years, and the pre-LVAD left ventricular ejection fraction (LVEF) was 16.5 ± 5.7%. Fasting glucose levels, HbA1c, and daily insulin requirement within 1 month before and an average of 4.0 ± 2.3 months after LVAD placement were 157.7 ± 50.6 vs. 104.1 ± 21.4 mg/dL, 7.7 ± 0.9 vs. 6.0 ± 0.8.%, and 53.3 ± 51.7 vs. 24.2 ± 27.2 IU, respectively (P < 0.05 for all comparisons). Six of the 15 patients were completely free of antidiabetic medications and had blood glucose < 126 mg/dL as well as HbA1c < 6% after LVAD. Body mass index (BMI) was slightly increased after LVAD (28.7 ± 5.3 vs. 30.2 ± 4.1 kg/m², P NS).
  
  
  CONCLUSIONS
  Restoration of normal cardiac output after LVAD implantation improves diabetic control in patients with advanced CHF. Additional studies are warranted to determine the mechanisms that worsen or possibly induce DM in patients with advanced CHF.
authors.affiliation: Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. urielnir@gmail.com
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Pak
authors.forename: Vlad
authors.initials: V
authors.lastname: Cotarlan
authors.forename: Jeanine B
authors.initials: JB
authors.lastname: Albu
authors.forename: Dympna
authors.initials: D
authors.lastname: Gallagher
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
authors.forename: Henry N
authors.initials: HN
authors.lastname: Ginsberg
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose