LVAD in Heart Failure Linked to Improved Glycemic Control
For every 1% increase in baseline HbA1c there was a 0.7% reduction, according to a random effects meta-aggression analysis.
Patients with heart failure and diabetes who received a left ventricular assist device (LVAD) for their heart failure also had improvements in markers such as hemoglobin A1c (HbA1c), fasting plasma glucose, and daily insulin requirements, according to the results of a study published in ESC Heart Failure.
Glycemic control measurements from patients with heart failure receiving an LVAD were obtained from a search of the MEDLINE and Scopus databases utilizing the following search terms: diabetes, diabetes mellitus, type 2 diabetes mellitus, insulin, insulin resistance, hemoglobin A, glycosylated, haemoglobin A1c, blood glucose, heart assist device, left ventricular assist device, LVAD, and mechanical circulatory support. Primary outcome was the effects of the device on HbA1c levels and secondary outcome was the effects of the device on other glycemic control end points.
Of the 485 initial hits in the database searches, 13 studies (820 participants) met the inclusion criteria and were included in the meta-analysis. In the primary study outcome, HbA1c levels following implantation were statistically significantly lower (1.23%; 95% CI, –1.49 to –0.98) than before surgery; for every 1% increase in baseline HbA1c, there was a 0.7% reduction (P <.01), according to a random effects meta-aggression analysis. In the secondary outcomes, fasting blood glucose, insulin requirements, and serum creatinine levels were significantly reduced. No correlation between body mass index and device implantation were found.
The investigators wrote, “Our meta-analysis showed significant improvements in glycemic control, including lower HbA1c and plasma glucose levels as well as reduced daily insulin needs in advanced [heart failure] patients who received an LVAD.”
They added, “Clinicians caring for advanced [heart failure] patients who have received an LVAD need to be cognizant of these anticipated glycemic changes and adjust patients' drug regimens accordingly.”
Patel N, Gluck J, Radojevik J, et al. Left ventricular assist device implantation improves glycaemic control: a systematic review and meta-analysis [published online July 27, 2018]. ESC Heart Failure. doi:10.1002/ehf2.12337