Clinical features of atrial fibrillation in patients with type 2 diabetes mellitus

Atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) are among the most common chronic diseases. Their coexistence is associated with an increased risk of cardiovascular complications and an unfavorable clinical prognosis, which underscores the need to study the impact of carbohydrate metabolism disorders on the clinical course of AF. Purpose: Assessment of the relationship between the presence of type 2 diabetes mellitus, the duration of the disease, the quality of glycemic control, and the clinical features of atrial fibrillation in patients with a combination of these diseases. Materials and methods: This retrospective observational study included 1,307 patients with AF who were hospitalized between 2020 and 2025. The patients were divided into two groups: AF without T2DM (433 patients) and AF combined with T2DM (874 patients). In the T2DM group, additional stratification was performed according to achievement of target glycated hemoglobin (HbA1c) levels, disease duration, presence of diabetic micro- and macroangiopathy, thrombotic complications, and the type of glucose-lowering therapy. The clinical forms of AF, frequency and duration of arrhythmia episodes, as well as the frequency and length of hospitalizations were assessed. Results and discussion: The study demonstrated that the presence of T2DM is associated with a more severe clinical course of AF. Patients with T2DM more frequently exhibited persistent, long-standing persistent, and permanent forms of arrhythmia. They also showed an increased frequency and duration of AF episodes, a higher need for inpatient treatment, and longer hospital stays. Failure to achieve target HbA1c levels was associated with a higher frequency of arrhythmia episodes, increased hospitalization rates, and prolonged inpatient stays. The most unfavorable disease course was observed in patients with a T2DM duration of more than 10 years and in those with chronic microvascular and macrovascular complications. The combination of AF and T2DM complicated by thrombotic events was characterized by the highest frequency and longest duration of arrhythmia episodes, as well as the longest hospitalization periods. Conclusions: Thus, the study results highlight the key role of T2DM and its associated cardiovascular complications in the development of an unfavorable course of AF and substantiate the need for a comprehensive management approach in this patient population.