title: 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.
authors.affiliation: From the *Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York and †Division of Endocrinology and Metabolism, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Naila
authors.initials: N
authors.lastname: Choudhary
authors.forename: Leway
authors.initials: L
authors.lastname: Chen
authors.forename: Lisa
authors.initials: L
authors.lastname: Kotyra
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wittlin
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Alexis
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D048909:Diabetes Complications / Q000097:blood* / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human