Investigating the ‘Diabetes Paradox’ in Takotsubo Cardiomyopathy

Background The impact of diabetes mellitus (DM) on outcomes of Takotsubo cardiomyopathy (TC) remains unclear, with conflicting evidence suggesting either protective or harmful effects. This study evaluates the association between DM and in-hospital outcomes in TC patients.Methods A retrospective analysis of the National Inpatient Sample database (2016–2019) was conducted to compare in-hospital outcomes in TC patients with and without DM. The primary outcome was in-hospital mortality, while secondary outcomes included cardiac arrest, cardiogenic shock, and acute kidney injury (AKI). Propensity-score matching (PSM) was applied to balance covariates, and multivariable logistic regression was used to evaluate DM as an independent predictor of mortality, with results reported as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Results Of 63,155 TC hospitalizations 13,380 (21.2%) involved patients with DM, who were older and had higher rates of comorbidities. PSM analysis revealed a higher risk of AKI in DM patients (20.13% vs. 15.91%; OR, 1.33; 95% CI, 1.16–1.54; p < 0.001), with no significant differences in mortality, cardiogenic shock, or cardiac arrest. Patients with diabetic neuropathy showed a non-significant trend toward increased AKI risk (27.04% vs. 20.44%; OR, 1.44; 95% CI, 1.00–2.09; p = 0.053). Multivariable analysis identified comorbidities like CKD, liver disease, and coagulopathy as mortality predictors, but not DM.Conclusion DM was associated with a higher risk of AKI but did not affect in-hospital mortality or major cardiac events in TC patients. These findings suggest that DM has a neutral impact on TC outcomes, highlighting the need for further investigation.