Impact of left ventricular assist device on diabetes management: an evaluation through case analysis and clinical impact.

BACKGROUND: Diabetes is a major risk factor for the development of heart failure (HF). In patients with advanced HF, left ventricular assist devices (LVADs) are increasingly used as a bridge to heart transplantation and destination therapy. It has been our observation that, post-LVAD implantation, diabetes management improves dramatically.
OBJECTIVE: We evaluated insulin requirements in a group of type 2 diabetes patients after LVAD implantation, compared them to a small control group, and performed a pertinent literature review.
METHODS: Relevant clinical and biochemical data were collected by chart review of 11 patients with known type 2 diabetes mellitus and HF who underwent LVAD implantation. Patients treated only with insulin were evaluated and compared with 5 control patients undergoing other cardiac procedures.
RESULTS: Insulin requirement decreased by 73% at 6 months from the pre-LVAD dose despite no significant changes in weight or glomerular filtration rate. Mean hemoglobin A1c reduced post-LVAD to 6.4% from 8.6%. Patients undergoing other cardiac procedures showed no significant changes in hemoglobin A1c or insulin requirements.
CONCLUSION: Patients with diabetes undergoing LVAD implantation demonstrated a significant reduction in insulin requirements. This finding underscores the importance of HF in the progression of insulin resistance.