连续流左心室辅助装置植入对2型糖尿病合并晚期慢性收缩性心力衰竭患者血糖控制的积极影响。

Positive Impact of Continuous-Flow Left Ventricular Assist Device Implantation on Glycemic Control in Patients with Type 2 Diabetes Mellitus and Advanced Chronic Systolic Heart Failure.

作者信息

Yen Debbie C, Watson Mara H, Burgess Lindsey D, Kuchibhatla Maragatha, Patel Chetan B, Campbell Kristen B, Vora Alyssa K

机构信息

Department of Pharmacy, Duke University Hospital, Durham, North Carolina.

Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.

出版信息

Pharmacotherapy. 2016 Dec;36(12):1210-1216. doi: 10.1002/phar.1853. Epub 2016 Nov 28.

DOI:10.1002/phar.1853

PMID:27779786

Abstract

STUDY OBJECTIVE

To evaluate the impact of continuous-flow left ventricular assist device (LVAD) implantation on glycemic control in patients with type 2 diabetes mellitus and advanced chronic systolic heart failure.

DESIGN

Retrospective medical record review.

SETTING

Large academic tertiary and quaternary care hospital.

PATIENTS

Eighty-three adults with type 2 diabetes mellitus and advanced chronic systolic heart failure who underwent implantation of a continuous-flow LVAD between July 1, 2008, and June 30, 2013.

MEASUREMENTS AND MAIN RESULTS

Baseline demographic data and laboratory values pertinent to glycemic control (hemoglobin A [A1C], total daily insulin requirements, noninsulin antidiabetic medication use, and body mass index [BMI]) were collected for each patient. Pre-LVAD data were compared with data obtained during the 24 months after LVAD implantation. The mean age of the study population was 61.3 years, 70% were men, and 63% had ischemic cardiomyopathy. The first available mean ± SD A1C after LVAD implantation was 6.21 ± 1.5% at a median of 4.8 months (interquartile range 3.3-8.9), which represented a significant decrease from the pre-LVAD A1C of 7.46 ± 1.5% (p<0.001). Average daily insulin requirements decreased by 22.9 units at the end of 24 months (p<0.001). Over half of patients with prescriptions for noninsulin antidiabetic medications were able to discontinue therapy by the end of the study. Of note, BMI increased in the second year after LVAD implantation from a baseline of 32.3 kg/m to 34.9 kg/m (p=0.004). Regression analysis revealed that baseline A1C was the only independent predictor of change in A1C.

CONCLUSION

LVAD implantation was associated with a significant improvement in glycemic control. Further prospective studies are needed to evaluate the long-term impact of LVAD implantation on the clinical course of diabetes.

摘要

研究目的

评估连续流左心室辅助装置（LVAD）植入对2型糖尿病合并晚期慢性收缩性心力衰竭患者血糖控制的影响。

设计

回顾性病历审查。

地点

大型学术三级和四级医疗机构。

患者

83例2型糖尿病合并晚期慢性收缩性心力衰竭的成年人，于2008年7月1日至2013年6月30日期间接受了连续流LVAD植入。

测量指标及主要结果

收集每位患者的基线人口统计学数据以及与血糖控制相关的实验室值（糖化血红蛋白[A1C]、每日胰岛素总需求量、非胰岛素类抗糖尿病药物使用情况和体重指数[BMI]）。将LVAD植入前的数据与LVAD植入后24个月内获得的数据进行比较。研究人群的平均年龄为61.3岁，70%为男性，63%患有缺血性心肌病。LVAD植入后首次获得的平均±标准差A1C在中位数4.8个月时为6.21±1.5%（四分位间距3.3 - 8.9），与LVAD植入前的A1C 7.46±1.5%相比有显著下降（p<0.001）。24个月末每日胰岛素平均需求量减少了22.9单位（p<0.001）。超过一半使用非胰岛素类抗糖尿病药物处方的患者在研究结束时能够停止治疗。值得注意的是，LVAD植入后第二年的BMI从基线的32.3 kg/m²增加到34.9 kg/m²（p = 0.004）。回归分析显示，基线A1C是A1C变化的唯一独立预测因素。