Impact of Continuous-Flow LVAD Implantation on Glycemic Control
Does left ventricular assist device (LVAD) implantation improve glycemic control?
This single-center retrospective study included adults with type 2 diabetes and advanced chronic systolic heart failure (HF) who underwent LVAD implantation between 2008 and 2013 at a large academic tertiary and quaternary care hospital. The primary endpoint was change in hemoglobin A1c before and after LVAD implantation.
A total of 83 patients met inclusion criteria. The mean age was 61.3 ± 11.8 years, and the majority of study patients was male, white, and had a body mass index of ≥30 kg/m2. Ischemic cardiomyopathy was the most common etiology of HF, and 89% of patients were New York Heart Association Functional Class IV. The mean pre-LVAD A1c was 7.46 ± 1.5%, which significantly decreased to 6.21 ± 1.5% (p < 0.001) based on the first available postoperative A1c after LVAD implantation (median of 4.8 months). This improvement in A1c remained significant throughout the 24-month follow-up period. At the end of the 24 months, insulin requirements decreased by nearly 23 units from baseline, and 12 of the 42 patients receiving insulin monotherapy discontinued insulin during the follow-up period. Additionally, over half of those on noninsulin antidiabetic medications discontinued therapy by study end. A prespecified regression analysis showed that only preoperative A1c predicted change in A1c (R2 = 0.33).
A significant improvement in glycemic control was observed after LVAD implantation. A larger prospective study is warranted to determine the impact of the improvement in glycemic control with LVAD implantation on diabetes-related complications.
The findings from this study are consistent with smaller studies of shorter duration. Clearly, clinicians involved in the management of patients receiving an LVAD should be aware of the need to potentially modify insulin doses and noninsulin antidiabetic medications to avoid hypoglycemia. It should also be noted that A1c trended upward over time, indicating the need for continued close monitoring of glycemic control after LVAD implantation.
Keywords: Heart Failure, Cardiac Surgical Procedures
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