Complex interrelationship and therapeutic advances in diabetic patients with atrial fibrillation

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.