Complex interrelationship and therapeutic advances in diabetic patients with atrial fibrillation

Sep 28, 2026

Uploaded by Sarah

Diabetes mellitus and atrial fibrillation (AF) frequently coexist, where diabetes increases the risk of new-onset AF and worsens prognosis. Shared pathophysiological drivers include chronic inflammation, oxidative stress, atrial remodeling, autonomic dysfunction, advanced glycation end-products, and epicardial adiposity. Although AF management in diabetic patients remains challenging, guideline-directed anticoagulation, individualized rate and rhythm control, and newer antidiabetic therapies—especially SGLT2 inhibitors and GLP-1 receptor agonists—may improve AF outcomes. A comprehensive individualized strategy is essential to reduce morbidity and mortality.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages17

Reading Time43 min

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| W | J | C | World Journal of
Cardiology | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Cardiol 2025 December 26; 17(12): 114575 DOI: 10.4330/wjc.v17.i12.114575 ISSN 1949-8462 (online) REVIEW Complex interrelationship and therapeutic advances in diabetic patients with atrial fibrillation Aikaterini-Eleftheria Karanikola, Dimitrios Tsiachris, Nikos Argyriou, Michail Botis, Konstantinos Pamporis, Panagiotis Xydis, Christos Fragoulis, Athanasios Kordalis, Konstantinos Tsioufis Specialty type: Cardiac and cardiovascular systems Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade A, Grade A Novelty: Grade B, Grade B Creativity or Innovation: Grade B, Grade B Scientific Significance: Grade B, Grade B P-Reviewer: Mohammed Ali U, Senior Scientist, Ethiopia Received: September 24, 2025 Revised: October 8, 2025 Accepted: November 10, 2025 Published online: December 26, 2025 Processing time: 91 Days and 15.7 Hours Aikaterini-Eleftheria Karanikola, Dimitrios Tsiachris, Nikos Argyriou, Michail Botis, Konstantinos Pamporis, Panagiotis Xydis, Christos Fragoulis, Athanasios Kordalis, Konstantinos Tsioufis, First Department of Cardiology, National and Kapodistrian University of Athens,“Hippokration”General Hospital, Athens 11527, Greece Corresponding author: Dimitrios Tsiachris, Assistant Professor, First Department of Cardiology, National and Kapodistrian University of Athens,“Hippokration” General Hospital, Vas. Sofias 114, Athens 11527, [Greece.](Greece. dtsiachris@yahoo.com)[ dtsiachris@yahoo.com](Greece. dtsiachris@yahoo.com) Abstract Diabetes mellitus and atrial fibrillation (AF) are two global epidemics that frequently coexist, with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis. Pathophysiological mechanisms underlying this relationship include chronic inflammation, oxidative stress, atrial remodeling, autonomic dysfunction, advanced glycation end-products and epicardial adiposity. Management remains challenging; however, recent advances offer promise, including guideline-directed anticoagulation, tailored rate and rhythm control, and particularly, novel antidiabetic therapies, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, may improve AF outcomes. A comprehensive, individualized approach is essential to mitigate morbidity and mortality in this high-risk population. Key Words: Diabetes mellitus; Atrial fibrillation; Arrhythmia; Atrial remodeling; Pathophysiology; Management ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. Core Tip: Diabetes and atrial fibrillation are closely related conditions that increase cardiovascular risk through shared mechanisms of metabolic dysfunction, inflammation and atrial remodeling. Their coexistence complicates treatment decisions, yet novel strategies are reshaping care. Beyond optimized anticoagulation and rhythm control, emerging antidiabetic agents show promise in improving outcomes. This comprehensive review highlights current evidence, evolving therapies and the need for individualized management to reduce the burden of morbidity and mortality in this population. WJC [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 26, 2025 Volume 17 Issue 12 Karanikola AE et al. Mechanisms and treatment of diabetes and AF Citation: Karanikola AE, Tsiachris D, Argyriou N, Botis M, Pamporis K, Xydis P, Fragoulis C, Kordalis A, Tsioufis K. Complex interrelationship and therapeutic advances in diabetic patients with atrial fibrillation. World J Cardiol 2025; 17(12): 114575 URL: [https://www.wjgnet.com/1949-8462/full/v17/i12/114575.htm](https://www.wjgnet.com/1949-8462/full/v17/i12/114575.htm) DOI: [https://dx.doi.org/10.43

FAQs

Why do diabetes mellitus and atrial fibrillation often coexist?

They share mechanisms that promote AF development and deterioration, including chronic inflammation, oxidative stress, atrial remodeling, autonomic dysfunction, advanced glycation end-products, and epicardial adiposity.

How does diabetes affect atrial fibrillation outcomes?

Diabetes increases the risk of new-onset AF, contributes to suboptimal arrhythmia control, and is linked to poor prognosis in patients with AF.

What therapeutic advances are highlighted for diabetic patients with AF?

The review emphasizes guideline-directed anticoagulation, tailored rate and rhythm control, and novel antidiabetic therapies such as SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists to potentially improve AF outcomes.

Sep 28, 2026

Uploaded by Sarah