title: Impact of left ventricular assist device on diabetes management: an evaluation through case analysis and clinical impact.
abstract: BACKGROUND
  Diabetes is a major risk factor for the development of heart failure (HF). In patients with advanced HF, left ventricular assist devices (LVADs) are increasingly used as a bridge to heart transplantation and destination therapy. It has been our observation that, post-LVAD implantation, diabetes management improves dramatically.
  
  
  OBJECTIVE
  We evaluated insulin requirements in a group of type 2 diabetes patients after LVAD implantation, compared them to a small control group, and performed a pertinent literature review.
  
  
  METHODS
  Relevant clinical and biochemical data were collected by chart review of 11 patients with known type 2 diabetes mellitus and HF who underwent LVAD implantation. Patients treated only with insulin were evaluated and compared with 5 control patients undergoing other cardiac procedures.
  
  
  RESULTS
  Insulin requirement decreased by 73% at 6 months from the pre-LVAD dose despite no significant changes in weight or glomerular filtration rate. Mean hemoglobin A1c reduced post-LVAD to 6.4% from 8.6%. Patients undergoing other cardiac procedures showed no significant changes in hemoglobin A1c or insulin requirements.
  
  
  CONCLUSIONS
  Patients with diabetes undergoing LVAD implantation demonstrated a significant reduction in insulin requirements. This finding underscores the importance of HF in the progression of insulin resistance.
authors.affiliation: Department of Internal Medicine, University of Mississippi, Jackson, MS.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Subauste
authors.forename: Nazanene H
authors.initials: NH
authors.lastname: Esfandiari
authors.forename: Yunyan
authors.initials: Y
authors.lastname: Qu
authors.forename: Elif A
authors.initials: EA
authors.lastname: Oral
authors.forename: Keith D
authors.initials: KD
authors.lastname: Aaronson
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.forename: Roma G
authors.initials: RG
authors.lastname: Gianchandani
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006333:Heart Failure / Q000453:epidemiology* / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin