Atrial fibrillation: an underappreciated complication of diabetes

Atrial fibrillation (AF) should be recognized as a complication of diabetes, with a prevalence of up to 25% and increasing incidence rates in individuals with diabetes. Atrial fibrillation can develop in individuals with diabetes independent of hypertension, atherosclerotic cardiovascular disease, or heart failure. The pathogenesis linking diabetes to AF is multifactorial, involving atrial structural, electrical, electromechanical, and autonomic remodelling, as well as diabetes-related metabolic comorbidities. Given that the prevalence of diabetes (mainly Type 2 diabetes) is expected to increase further, the coexistent burden of AF on individuals, society, and healthcare systems will continue to increase. Thus, an integrated CARE-based management approach should be adopted to optimize care for diabetic patients across all stages of those at risk for AF and those with subclinical or clinical AF. This includes Comorbidity and risk factor management, Avoidance of stroke and thromboembolism, Reduction of symptoms by rate and rhythm control, and Evaluation and dynamic reassessment. This review outlines the intricate and close relationship between diabetes and AF, addressing the epidemiology, pathogenesis, and management strategies based on the CARE-based approach in diabetic patients. Such consideration may facilitate timely prevention, early detection, and effective intervention, ultimately improving the health outcomes of patients with AF and diabetes.