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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.<\/jats:p>","DOI":"10.1093\/eurheartj\/ehag044","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T12:25:14Z","timestamp":1768911914000},"page":"1511-1526","source":"Crossref","is-referenced-by-count":5,"title":["Atrial fibrillation: an underappreciated complication of diabetes"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1398-6147","authenticated-orcid":false,"given":"Lingli","family":"Cai","sequence":"first","affiliation":[{"name":"Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine , Shanghai 200011 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, The Eighth Affiliated Hospital, Southern Medical University (The First People\u2019s Hospital of Shunde) , Foshan, Guangdong ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8529-3521","authenticated-orcid":false,"given":"Ying","family":"Sun","sequence":"additional","affiliation":[{"name":"Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine , Shanghai 200011 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4106-9771","authenticated-orcid":false,"given":"Melissa E","family":"Middeldorp","sequence":"additional","affiliation":[{"name":"Centre for Heart Rhythm Disorders, University of Adelaide , Adelaide ,","place":["Australia"]},{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shanghai Tenth People\u2019s Hospital, Tongji University School of Medicine , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8041-7791","authenticated-orcid":false,"given":"Lu","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University , New Orleans, LA, USA"},{"name":"Department of Nutrition, Harvard T.H. 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