Improved inpatient glycemic control and reduced insulin requirements in diabetic patients with advanced heart failure treated with left ventricular assist devices

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 758-779-Cardiometabolic Risk & Vascular Biology
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-760
Aashish Ajit Shah*, Gayatri Jaiswal, Jason Prater, Ali R Shoraka, Victor Joseph Bernet, Parag Patel and Gunjan Yogendra Gandhi
Mayo Clinic, Jacksonville, FL
Background: Left ventricular assist devices (LVAD) are increasingly being used for treatment of advanced heart failure patients, a large number of whom have diabetes. An association between insulin resistance and heart failure has long been recognized with recent evidence suggesting that congestive heart failure may cause insulin resistance. 

Objective: To assess the impact of improved cardiac output with LVADs on glycemic control and insulin requirements in hospitalized diabetic patients with advanced heart failure.

Methods: Single center, retrospective observational study of adults with diabetes and advanced heart failure undergoing axial flow LVAD implantation between January, 2007, and September, 2012, at Mayo Clinic Florida. Diabetes care was uniform for all patients, managed by the diabetes consulting service. Primary end points were changes during hospital stay in mean blood glucose and total daily dose of insulin which were measured up to seven days before, and for seven days after, LVAD placement.

Results: We included 30 consecutive patients in the study with mean diabetes duration of 10 years.  Average age of subjects was 57 years, with 27 patients being male. Twenty-two of the 30 patients (73%) had type 2 diabetes mellitus. Twenty-five of the 30 patients (83%) had ischemic cardiomyopathy. Mean body mass index of subjects was 31 kg/m2.  Mean (± SD) blood glucose of all patients prior to device placement was 166 ± 42 mg/dL which significantly reduced by 11% to 150 ± 15 mg/dL through hospital day 7 (p=0.006). Total mean daily dose of insulin also decreased significantly by 15%, through hospital day 7 (pre vs. post device placement: 35 ± 59 vs. 29 ± 52 units, p=0.012).  There were a total of 17 hypoglycemic events (defined as blood glucose < 60 mg/dL) and 4 severe hypoglycemic events (defined as blood glucose < 50 mg/dL) after LVAD placement.

Conclusions: Increased cardiac output after LVAD placement significantly improved inpatient glucose control and reduced total daily insulin requirements. The impact of these data should heighten awareness for potential inpatient hypoglycemia. Routine hospital glucose monitoring and close evaluation of daily insulin requirements are necessary. Additional studies seem warranted to ascertain long term impact on glycemic control with axial flow LVADs.

Nothing to Disclose: AAS, GJ, JP, ARS, VJB, PP, GYG

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