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

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posted on 2023-10-18, 15:08 authored by Soonil Kwon, So‑Ryoung Lee, Eue‑Keun Choi, Hyo-Jeong Ahn, Seung Woo Lee, Jin Hyung Jung, Kyung‑Do Han, Seil Oh, Gregory Y. H. Lip

Objective: This study aimed to investigate the associations between concurrent atrial fibrillation and diabetes-related complications among patients with diabetes mellitus.

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).

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).

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.


This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC21C0028), and by the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: HI20C1662, 1711138358, KMDF_PR_20200901_0173). The funding sources had no role in the study.


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