Diabetes mellitus, glycemic control, and risk of atrial fibrillation
Open accessAbstract
Background Diabetes may be an independent risk factor for atrial fibrillation. However, results from prior studies are in conflict, and no study has examined diabetes duration or glycemic control.Objective To examine the association of diabetes with risk of atrial fibrillation and to describe risk according to diabetes duration and glycemic control.Design A population-based case-control study.Participants Within a large, integrated healthcare delivery system, we identified 1,410 people with newly-recognized atrial fibrillation from ICD-9 codes and validated cases by review of medical records. 2,203 controls without atrial fibrillation were selected from enrollment lists, stratified on age, sex, hypertension, and calendar year.Main measures Information on atrial fibrillation, diabetes and other characteristics came from medical records. Diabetes was defined based on physician diagnoses recorded in the medical record, and pharmacologically treated diabetes was defined as receiving antihyperglycemic medications. Information about hemoglobin A1c levels came from computerized laboratory data.Key results Among people with atrial fibrillation, 252/1410 (17.9%) had pharmacologically treated diabetes compared to 311/2203 (14.1%) of controls. The adjusted OR for atrial fibrillation was 1.40 (95% CI 1.15-1.71) for people with treated diabetes compared to those without diabetes. Among those with treated diabetes, the risk of developing atrial fibrillation was 3% higher for each additional year of diabetes duration (95% CI 1-6%). Compared to people without diabetes, the adjusted OR for people with treated diabetes with average hemoglobin A1c <or=7 was 1.06 (95% CI 0.74-1.51); for A1c >7 but <or=8, 1.48 (1.09-2.01); for A1c >8 but <or=9, 1.46 (1.02-2.08); and for A1c >9, 1.96 (1.22-3.14).Conclusions Diabetes was associated with higher risk of developing atrial fibrillation, and risk was higher with longer duration of treated diabetes and worse glycemic control. Future research should identify and test approaches to reduce the risk of atrial fibrillation in people with diabetes.
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When diabetes and atrial fibrillation co-exist, there is a substantially higher risk of all-cause death, cardiovascular death, stroke, kidney disease, and heart failure, regardless of diabetes type.
“Diabetes and AF frequently co-exist, and when this occurs, there is a substantially higher risk of all-cause death, CV death, stroke, kidney disease, and HF, regardless of diabetes type.541,577,[591][592][593][594][595][596]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [591]
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References 43 · Cited by 310
- Authors
- Dublin, S., Glazer, N. L., Smith, N. L., Psaty, B. M., Lumley, T., Wiggins, K. L., Page, R. L., & Heckbert, S. R.
- Affiliations
- Kaiser Permanente Washington Health Research Institute (US)
- University of Washington (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Dublin, Sascha
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2010-04-20
- Volume
- 25
- Issue
- 8
- Pages
- 853-858
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2896589
- OpenAlex
- W1976872170
- Cited by
- 310
- References
- 43
- Citations by year
- 2026: 14 · 2025: 24 · 2024: 24 · 2023: 24 · 2022: 28 · 2021: 26 · 2020: 30 · 2019: 21 · 2018: 14 · 2017: 18 · 2016: 17 · 2015: 18 · 2014: 16 · 2013: 15 · 2012: 11
- FWCI
- 7.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- American Federation for Aging Research
- Hartford Foundation for Public Giving
- Sanofi
- Atlantic Philanthropies
- Starr Foundation
- Astellas Pharma
- National Institute on Aging (K23AG028954)
- National Heart, Lung, and Blood Institute (R01HL073410, HL43201, R01HL068986, R01HL068639, HL 68639, HL 68986, HL73410, R01HL043201)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, atrial fibrillation, glycemic control, HbA1c, diabetes duration, antihyperglycemic medications, cardiovascular risk factors
- MeSH terms
- Aged, Atrial Fibrillation, Blood Glucose, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Middle Aged, Risk Factors, Time Factors, Body Mass Index, Multivariate Analysis, Confidence Intervals, Logistic Models, Odds Ratio, Case-Control Studies, Diabetes Complications
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