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Left ventricular assist device implantation improves glycaemic control: a systematic review and meta-analysis

Nirav Patel1, Jason A Gluck1, Joseph Radojevic1

  • 1Center for Advanced Heart Failure & Pulmonary Vascular Disease, Department of Cardiology, Hartford Hospital, Hartford, CT, USA.

ESC Heart Failure
|July 28, 2018
PubMed

Insights

Left ventricular assist device (LVAD) implantation significantly improves diabetes mellitus (DM) control in advanced heart failure (HF) patients. This meta-analysis found lower HbA1c, fasting glucose, and insulin needs after LVAD implantation.

Area of Science:

  • Cardiology
  • Endocrinology
  • Medical Devices

Background:

  • Heart failure (HF) and diabetes mellitus (DM) frequently coexist, with a bidirectional relationship.
  • Advanced HF often leads to poorer glycemic control.
  • Left ventricular assist device (LVAD) implantation is a treatment for advanced HF.

Purpose of the Study:

  • To investigate the impact of LVAD implantation on diabetes mellitus (DM) control markers.
  • To analyze changes in glycosylated hemoglobin A1c (HbA1c), fasting glucose, and insulin requirements post-LVAD.

Main Methods:

  • Systematic literature search of MEDLINE and Cochrane databases up to October 2017.
  • Inclusion of 13 studies with 820 participants with advanced HF who received LVAD.
  • Pooled analysis using a Hartung-Knapp random-effects model to determine mean differences (MD) and 95% confidence intervals (CI).

Main Results:

  • LVAD implantation was associated with a significant reduction in HbA1c by 1.23% (95% CI -1.49 to -0.98).
  • Significant decreases were observed in fasting plasma glucose (-24.4 mg/dL) and daily insulin requirements (-18.8 units).
  • Serum creatinine levels also decreased, while body mass index (BMI) showed no significant change.

Conclusions:

  • LVAD implantation leads to significant improvements in glycemic control for advanced heart failure patients.
  • Key markers such as HbA1c, fasting plasma glucose, and insulin needs are favorably affected.
  • LVAD therapy offers a potential benefit for managing comorbid diabetes in advanced HF.
Abstract

Keywords:
Body mass indexDiabetes mellitusInsulinInsulin resistanceLeft ventricular assist deviceMechanical circulatory supportMeta-analysis

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