Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow‐up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study

Abstract

BackgroundThe electrocardiogram (ECG) is an objective tool for cardiovascular disease (CVD) risk assessment.Methods and ResultsWe evaluated distribution of ECG abnormalities and risk factors for developing new abnormalities in 1314 patients with type 1 diabetes (T1D) from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Annual ECGs were centrally read. ECG abnormalities were classified as major and minor according to the Minnesota ECG Classification. At EDIC year 1 (baseline), 356 (27.1%) of the participants had at least 1 ECG abnormality (major or minor) whereas 26 (2%) had at least one major abnormality. During 16 years of follow‐up, 1016 (77.3%) participants developed at least 1 new ECG abnormality (major or minor), whereas 172 (13.1%) developed at least 1 new major abnormality. Independent risk factors for developing new major ECG abnormalities were: age, current smoking, increased systolic blood pressure, and higher glycosylated hemoglobin (hazard ratio [HR] [95% CI]: 1.04 [1.02–1.06] per 1‐year increase, 1.75 [1.22–2.53], 1.03 [1.01–1.05] per 1 mm Hg increase, and 1.16 [1.04–1.29] per 10% increase, respectively). Independent risk factors for developing any new ECG abnormalities (major or minor) were age and systolic blood pressure (HR [95% CI]: 1.02 [1.01–1.03] per 1‐year increase and 1.01 [1.00–1.02] per 1 mm Hg increase, respectively).ConclusionsNew ECG abnormalities commonly occur in the course of T1D, consistent with the recognized increasing risk for CVD as patients age. Advanced age, increased systolic blood pressure, smoking, and higher HbA1c are independent risk factor for developing major ECG abnormalities, which underscores the importance of tight glucose control in T1D in addition to management of common CVD risk factors.

Cardiovascular Risk in Type 1 Diabetes Mellitus

“…The resting 12-lead electrocardiogram (ECG) is the most accessible test for CVD, and new ECG abnormalities were found to be common over follow-up in the EDIC study [ 74 ]. Age, HbA1c, systolic BP and smoking were reported to be independent risk factors for the development of new major ECG abnormalities.…”

Changes in QTc and PR Intervals among Indian Type 2 Diabetes Patients with Respect to Prevailing Glycated Hemoglobin Level: a Retrospective Analysis

“…The normal interval ranges between 120 to 200 ms. To the best of our knowledge, there are no available studies correlating PR interval findings with the parameters of diabetic control. However, Soliman et al found that a short PR interval was the [58]. Additionally, Carrazco et al have recently found that the incidence of paroxysmal atrial fibrillation and flutter has been associated with both prolonged PR interval (> 175 ms) and low HbA1C [59].…”

Type 1 diabetes is associated with T-wave morphology changes. The Thousand & 1 Study

“…25 In the EDIC study, 16 % had microalbuminuria after an average T1DM duration of 14 years. 26 In a Spanish study of asymptomatic patients with T1DM and without known coronary heart disease the mean diabetes duration was 20 years and microalbuminuria was found in only 9% of patients. 27 However, no patients above 50 were included in that study, which might in part explain the low prevalence.…”

“…4.1 % of patients with T1DM were treated with betablockers, 42.3 % took angiotensin converting enzyme inhibitors or angiotensin II receptor blockers to lower blood pressure,26.1 % used medication containing acetylsalicylic acid, and 16.3 % took calcium channel blockers. The use of medication was more prevalent with increasing degree of albuminuria for all of these medications.…”