Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence. A report from the Non-invasive Monitoring for Early Detection of Atrial Fibrillation (NOMED-AF) prospective cross-sectional observational study

Abstract Background: Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. Methods: From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. Results: The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p<0.001), p=0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p=0.027) and LDL<100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p=0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p<0.001), LDL<100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p=0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p=0.031) and HbA1c ≤6.5 (OR 0.46, 95%CI: 0.25-0.85, p=0.013) were associated with silent AF prevalence. Conclusions: Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤6.5 being additional independent predictors for silent AF. Trial registration: NCT03243474