Mechanical circulatory support improves diabetic control in patients with advanced heart failure

Aims Left ventricular assist devices (LVADs) are increasingly being used as life-saving therapy for end-stage advanced heart failure. Diabetes is prevalent in advanced heart failure patients. In this study, we sought to investigate the effects of mechanical circulatory support on diabetic parameters with LVAD implantation.

Methods and results In this retrospective study, data on 244 LVAD recipients between 2006 and 2013 were reviewed. Patients without history of diabetes, death within the first 3 months after LVAD implantation, heart transplantation after LVAD, or LVAD explantation were excluded from the study. Baseline demographic, laboratory, and echocardiographic information prior to LVAD placement and 6-month follow-up were obtained. Laboratory values indicative of diabetic control were found to improve significantly at 6 months post-LVAD implantation (glycated haemoglobin, 7.2 vs. 6.1%, P-<-0.0001; serum fasting glucose, 141 vs. 122-mg/dL, P-=-0.003; mean daily insulin dose, 30 vs. 24 IU/day, P-=-0.02). Additionally, the use of oral hypoglycaemic medication was successfully discontinued in six patients at 6 months post-LVAD implantation.

Conclusions Long-term LVAD therapy is associated with improvement in diabetic control which is probabvly due to improvements in cardiac output and normalization of biochemical derangements resulting from diabetes.