The QT interval reflects the total duration of ventricular myocardial depolarization and repolarization: a prolonged QT interval is associated with sudden death and poor survival in apparently healthy subjects [1]. The relation of QT interval prolongation with diabetes complications, poor survival prognosis and sudden death has recently received considerable interest. It has been postulated that QT prolongation accounts for higher mortality in people with diabetes and its complications as the prevalence of QT interval prolongation is higher among patients with Type I (insulin-dependent) diabetes mellitus [2], ischaemic heart disease (IHD) [3±7], end stage renal disease [8] and autonomic neuropathy [2, 9±12].Data on QT interval in diabetic patients are, however, mainly derived from small, selected samples [9±15]. In particular, the prevalence of QT interval prolongation and its relation with cardiac autonomic neuropathy has been evaluated in only one cross-sec- Diabetologia (1999) Summary The prevalence of QT interval prolongation is higher in people with diabetes and its complications. Sudden death has been reported as a common cause of death in insulin-dependent diabetic patients affected by autonomic neuropathy. It has been postulated that QT prolongation predisposes to cardiac arrhythmias and sudden death. In this analysis the prevalence of QT interval prolongation and its relation with diabetic complications were evaluated in the EURODIAB IDDM Complications Study (3250 insulin-dependent diabetic patients attending 31 centres in 16 European countries). Five consecutive RR and QT intervals were measured with a ruler on the V5 lead of the resting ECG tracing and the QT interval corrected for the previous cardiac cycle length was calculated according to the Bazett's formula. The prevalence of an abnormally prolonged corrected QT was 16 % in the whole population, 11 % in males and 21 % in females (p < 0.001). The mean corrected QT was 0.412 s in males and 0.422 s in females (p < 0.001). Corrected QT duration was independently associated with age, HbA 1 c and blood pressure. Corrected QT was also correlated with ischaemic heart disease and nephropathy but this relation appeared to be stronger in males than in females. Male patients with neuropathy or impaired heart rate variability or both showed a higher mean adjusted corrected QT compared with male patients without this complication. The relation between corrected QT prolongation and autonomic neuropathy was not observed among females. In conclusion we have shown that corrected QT in insulin-dependent diabetic female patients is longer than in male patients, even in the absence of diabetic complications known to increase the risk of corrected QT prolongation. [Diabetologia (1999) 42: 68±75]

Abstract. Veglio M, Bruno G, Borra M, Macchia G, Bargero G, D'Errico N, Pagano GF, Cavallo-Perin P (Evangelico Valdese Hospital, Torino; University of Torino, Torino; and S. Spirito Hospital, Casale Monferrato; Italy). Prevalence of increased QT interval duration and dispersion in type 2 diabetic patients and its relationship with coronary heart disease: a population-based cohort. J Intern Med 2002; 251: 317-324.Objective. To evaluate the prevalence of prolonged QT interval and dispersion in a population-based cohort of type 2 diabetic patients and their relationship with clinical and metabolic variables. Design. Cross-sectional population-based cohort. Setting. Diabetes clinics and general practitioners in Casale Monferrato (Northern Italy). Subjects. A total of 1357 patients with known type 2 diabetes (70% of the cohort). Main outcome measures. Albumin excretion rate and coronary heart disease (CHD); a standard supine 12-lead electrocardiogram (ECG) was recorded and coded according to the Minnesota code criteria. QT interval corrected for heart rate (QTc) > 0.44 s and QTc dispersion > 0.080 s were considered abnormally prolonged.Results. Prevalence of increased QTc duration and QTc dispersion were 25.8% (95% CI 23.5-28.3) and 33.1% (95% CI 30.6-35.7), with no sex differences. No metabolic differences were found, apart from fibrinogen and creatinine levels, which were higher in patients with increased QTc dispersion. Patients with CHD had higher mean adjusted values of QTc and QTc dispersion, whereas no association was found with albumin excretion rate (AER) and diabetes treatment. QTc duration and QTc dispersion were significantly correlated (0.17, P < 0.001). In multiple regression analysis, only CHD was independently associated with QTc, after adjustment for age and sex (b ¼ 0.010, P < 0.001, R 2 ¼ 2.5%); as regards QTc dispersion, a similar association with CHD was found (b ¼ 0.20, P < 0.001, R 2 ¼ 4.8%). Conclusions. This population-based study shows a considerably high prevalence of increased QTc and QTc dispersion in type 2 diabetic patients and their association with CHD. These findings have both epidemiological and clinical relevance, as they might be implicated in the excess mortality risk of type 2 diabetic patients.

Diabetic retinopathy (DR) remains a leading cause of loss of vision in Europe and North America [1±5] but the underlying pathogenesis is still not known, although a number of risk factors have been identified in the course of observation [6,7] and intervention studies [8]. In addition, despite improvements in metabolic control, proliferative DR (PDR) continues to occur, making epidemiological approaches to the problem useful. The EURODIAB Prospective Complications Study (PCS) investigated the largest cohort of patients with Type I (insulin-dependent) diabetes mellitus so far and was specifically designed to collect Diabetologia (2001)

A prolonged QT interval is considered an indicator of increased risk of malignant ventricular arrhythmias and/or sudden death. It has been proposed that autonomic neuropathy in diabetes is related to QT interval prolongation and increased mortality rates. Several studies in Type 1 and Type 2 diabetic patients have confirmed the independent relation between prolonged QT interval duration or increased QT interval dispersion and chronic ischemic heart disease. It has been consistently shown that autonomic neuropathy is related to QT interval duration while more controversies exist on the association with QT interval dispersion. In recent years, studies have confirmed the value of QT interval as a predictor of total mortality in both diabetic and non-diabetic subjects. Moreover, several studies have shown a significant relation between QT interval prolongation and cardiovascular disease risk factors. QT interval could be used to stratify the cardiovascular risk in diabetic patients. We still do not know why QT interval is prolonged and how this abnormality leads to death. Nevertheless, QT interval is a simple, low-cost measure, easily obtainable without the need of the patient's compliance and which could help to select patients who need second level diagnostic procedures and strict observation.

The prevalence of QT prolongation in a large random sample of Type 1 diabetic patients in Piemonte, Italy and its association with autonomic neuropathy were assessed. Three hundred and seventy-nine Type 1 diabetic patients (age 15-59) with (94, DAN+) and without (280, DAN-) autonomic neuropathy and 118 non-diabetic control subjects participated in the study. QT interval was measured on an ECG recorded at rest and QTc calculated according to Bazett's formula. QTc was greater than 0.440 s in 7.6% (95% CI 2.9-12.3) of control subjects, 25.6% (21.0-30.0) of diabetic patients, 30.8% (21.5-40.1) of DAN+, 23.9% (18.9-28.9) of DAN-. QTc was greater than 0.460 s (mean + 2SD of QTc in control subjects) in 11.7% (8.5-14.9) of diabetic patients, 18.1% (10.3-25.9) of DAN+, 9.6% (6.2-13.0) of DAN-. QT was above the 95% upper limit for the control subjects in the plot of measured QT against RR interval in 21.4% (17.3-25.5) of diabetic patients, 26.6% (17.7-35.5) of DAN+, 19.3% (14.7-23.9) of DAN-. No correlation was found between QT interval and age or disease duration. The prevalence of QT prolongation was higher in diabetic patients than in control subjects and in DAN+ than in DAN-.