The Association Between Atrial Fibrillation and Diabetes-Related Complications: A Nationwide Cohort Study

Abstract

<p dir="ltr">Objective: This study aimed to investigate the associations between concurrent atrial fibrillation and diabetes-related complications among patients with diabetes mellitus.</p><p dir="ltr">Research Design and Methods: This nationwide observational cohort study utilized the health check-up database from the Korean National Health Insurance Service. Patients diagnosed with diabetes mellitus who underwent health check-ups between 2009 and 2012 were investigated. The patients with atrial fibrillation were matched in a 1:5 ratio with those without atrial fibrillation using propensity scores. Study outcomes included macrovascular complications, microvascular complications (diabetic retinopathy and diabetic nephropathy), and diabetic foot. The risks of clinical outcomes were measured using hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p dir="ltr">Results: A total of 65,760 patients with diabetes mellitus were analyzed (54,800 without atrial fibrillation and 10,960 with atrial fibrillation). After well-balanced propensity-score matching, patients with atrial fibrillation were associated with significantly higher risks of macrovascular complications (HR 1.12, 95% CI 1.09–1.16), diabetic nephropathy (HR 1.23, 95% CI 1.16–1.30), and diabetic foot complications (HR 1.13, 95% CI 1.09–1.17) compared to patients without atrial fibrillation, while the risk of diabetic retinopathy was comparable (HR 0.99, 95% CI 0.96–1.03). The patients with atrial fibrillation had a significantly higher risk of diabetic foot amputation (HR 4.12, 95% CI 1.98–8.56).</p><p dir="ltr">Conclusions: Among patients with diabetes mellitus, concurrent atrial fibrillation was associated with increased risks for diabetes-related macrovascular and microvascular complications and diabetic foot complications. Such patients require holistic management to reduce the risk of adverse outcomes.</p>