Ekow ESSIEN, Abena AGYEKUM, Abraham CARBOO, Gloria AMOAKO, Justice OWUSU-ACHIAW
Journal of Updates in Cardiovascular Medicine - 2026;14(2):43-51
Objectives: Diabetes mellitus is a common comorbidity in patients with atrial fibrillation (AF), but the impact of glycemic control on clinical outcomes in this population remains incompletely characterized. This study aimed to compare clinical outcomes between AF patients with poorly controlled versus well-controlled diabetes mellitus. Materials and Methods: We performed a retrospective cohort study using the TriNetX Research Network, a global federated health research platform providing access to electronic medical records across 128 healthcare organizations. Adult patients (18-90 years) with type 2 diabetes mellitus and AF were stratified based on HbA1c levels: poorly controlled diabetes (HbA1c >=7.0%) and well-controlled diabetes (HbA1c <=6.9%). After propensity score matching for baseline demographics and comorbidities, cohorts of 332,060 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiogenic shock, heart failure, ventricular tachycardia, acute kidney injury (AKI), cerebrovascular disease, chronic kidney disease (CKD), coronary artery disease (CAD), and hypertension. Outcomes were analyzed using risk analysis and Kaplan-Meier survival analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) over a five-year follow-up period. Results: In this propensity-matched cohort study, patients with poorly controlled diabetes demonstrated significantly higher all-cause mortality compared to those with well-controlled diabetes (26.3% vs. 25.6%; HR: 1.070, 95% CI: 1.060-1.080; p<0.001). Poor glycemic control was associated with increased risk of heart failure (23.1% vs. 22.8%; HR: 1.071, 95% CI: 1.056-1.086; p<0.001), AKI (19.8% vs. 18.3%; HR: 1.132, 95% CI: 1.117-1.148; p<0.001), and CKD (19.4% vs. 17.8%; HR: 1.161, 95% CI: 1.145-1.178; p<0.001). Poorly controlled patients also had higher rates of CAD (18.3% vs. 17.9%; HR: 1.079, 95% CI: 1.062-1.096; p<0.001). Conversely, well-controlled diabetes was associated with reduced cardiogenic shock (2.2% vs. 2.3%; HR: 0.995, 95% CI: 0.963-1.028; p=0.771) and ventricular tachycardia (5.1% vs. 4.8%; HR: 0.977, 95% CI: 0.956-1.000; p=0.048). Conclusion: Among patients with diabetes mellitus and AF, poor glycemic control is associated with significantly increased mortality and higher rates of cardiovascular and renal complications. These findings emphasize the importance of optimal glycemic control in diabetic patients with AF to improve clinical outcomes and reduce adverse events.
