Diabetes + atrial fibrillation: A tricky combination

If you have diabetes, staying alert to atrial fibrillation is especially important.

Diabetes is a risk factor for atrial fibrillation. In general, people with diabetes have a 2-4 times greater risk of developing a heart condition (1).

For that reason, research and care guidelines are increasingly focusing on understanding how to best provide care to people who have diabetes and a cardiovascular condition such as atrial fibrillation.

Recognizing the connection between diabetes, atrial fibrillation and stroke is an important step towards lowering your risk. Learning about risk factors and the importance of addressing them can empower you to lead a healthier lifestyle and seek information and support from your health care provider about preventive measures.  

#1. Diabetes and atrial fibrillation are increasingly common

The prevalence of diabetes in growing rapidly in Europe. In the EU alone, there are already over 30 million individuals with diabetes, a number estimated to grow to 38 million by 2030. Many countries, such as Finland, Germany and Italy, are reporting that diabetes is expected to impact 1 in 10 individuals. The highest prevalence is in Spain and Portugal (2-4).

Simultaneously, the prevalence of atrial fibrillation is growing. Today, approximately 10 million people are impacted by atrial fibrillation in Europe (5).

Approximately 15% of people with diabetes also have atrial fibrillation (6).

At some point, prevention needs to play a larger role to tackle the growing trajectory.

#2. With diabetes, a-fib can be more asymptomatic

Typical symptoms of atrial fibrillation include a fast, fluttering or pounding heartbeat, dizziness and fatigue. However, approximately 1 in 3 people experience atrial fibrillation without any perceivable symptoms. For individuals with diabetes, this number is likely to be higher.

Bano et al. (7) found that people with diabetes are 25% less likely to notice their atrial fibrillation. The authors of the study raised the question of whether patients with diabetes should be systematically screened for silent atrial fibrillation.

Regular monitoring of heart rhythm is an especially important health habit for individuals with diabetes.

#3. Risk of ischemic stroke is higher

Atrial fibrillation is the single most significant cause of ischemic strokes. People with diabetes have a higher risk of suffering an ischemic stroke and are less likely to recover from it (6).

Early access to treatment can significantly reduce the risk of a stroke.

#4 Lifestyle choices make a huge impact

Managing your weight, blood pressure and not smoking have a big health impact in managing both your risk for developing atrial fibrillation or diabetes, and in managing both conditions if you already have them.

Read our blog about atrial fibrillation progression and the importance of managing risk factors.

#5. Screening recommendations are changing

With the growing burden of both diabetes and atrial fibrillation, screening is a topic of interest.

The rationale for advocating screening is the elevated stroke risk, the high number of individuals with significant risk factors, and the estimation that many remain undiagnosed. Underdiagnoses are partly caused by the fact that atrial fibrillation can present with mild or no perceivable symptoms.

The rationale against screening is based on concerns over cost-effectiveness and false positives, which could overburden health systems and cause anxiety in patients. In self-monitoring, using clinically validated technologies and medical devices is important to ensure safety and accuracy.

In 2023, the European Society of Cardiology updated its recommendations for screening atrial fibrillation in diabetes: All patients with diabetes should be screened for atrial fibrillation when there is an opportunity to do so (8).

References

1. Diabetes and Heart Disease | Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/diabetes-and-heart-disease 
 2. EU research on diabetes: https://research-and-innovation.ec.europa.eu/research-area/health/diabetes_en  

3. OECD: Health at a Glance: State of Health in the EU cycle. Diabetes prevalence (oecd-ilibrary.org)

4. Statista. Prevalence of diabetes in adult population in Europe (2021)

5. Zoni-Berisso M, et al. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014

6. Association of Atrial Fibrillation with Diabetes Mellitus, High Risk Comorbidities. Maedica (Bucur). 2022

7. Bano A, et al. Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities. J Am Heart Assoc. (2021)

8. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes