title: Improvement in blood glucose control in patients with diabetes after implantation of left ventricular assist devices.
abstract: Some reports suggest that the course of diabetes mellitus (DM) in heart failure (HF) may improve after implantation of left ventricular assist devices (LVADs). The objective of our study was to explore longitudinal changes in glycosylated hemoglobin (HbA1C) in patients with diabetes mellitus with advanced HF post-LVAD implantation. We retrospectively reviewed the records of all patients who received LVADs at our institution between 2002 and 2012 and selected those who 1) survived posthospital discharge and 2) had DM. We collected data on HbA1C before and after implantation of LVADs, daily doses of insulin, and antidiabetic drugs. Comparisons were done using Student's t-test. A total of 50 patients met the inclusion criteria. HbA1C was 7.6 ± 1.6 before LVAD, 5.7 ± 0.9 within 3 months after the LVAD implant (p = 0.0001), 6.1 ± 1.0 (p = 0.004 in comparison with pre-LVAD level) in 3-6 months after the implant, 6.3 ± 1.0 (p = 0.01) in 6-9 months, and 5.3 ± 0.1 in 9-12 months (p = 0.002). There were no significant changes in body mass index. Favorable changes in clinical course of diabetes in patients with HF occur after the implantation of LVADs, persist for at least 1 year after the implant, and are likely associated with improved hemodynamics and metabolism after normalization of cardiac output.
authors.affiliation: From the *Department of Cardiology, University of South Florida, Tampa, Florida; †Department of Medicine, University of South Florida, Tampa, Florida; and ‡Advanced Cardiothoracic Surgery and Tampa General Hospital, Tampa, Florida.
authors.forename: Maya
authors.initials: M
authors.lastname: Guglin
authors.forename: Kim
authors.initials: K
authors.lastname: Maguire
authors.forename: Taylor
authors.initials: T
authors.lastname: Missimer
authors.forename: Cristiano
authors.initials: C
authors.lastname: Faber
authors.forename: Christiano
authors.initials: C
authors.lastname: Caldeira
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D015992:Body Mass Index; D048909:Diabetes Complications / Q000378:metabolism / Q000628:therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006031:Glycosylation; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents