Abstract
Objectives: The aim of this study was to evaluate the prevalence and the risk factors of prolonged QTc interval among Egyptian patients with type 2 diabetes.
Patients and methods: We enrolled in this cross-sectional study from June 2011 to December 2015, a total of 220 patients (108 male & 112 female) with mean age 50.42± 7.453years diagnosed with type 2 DM.
Results: In this study, we found (33.6%) 74 T2 DM patients with QTc>440 ms had statistically significant longer diabetes duration and, diastolic BP, Total cholesterol. LDL-C and UACR with 146 type 2 DM patients with ≤ 440QTc ms (P value ≤ 0.05). Also statistically significant higher incidence of insulin therapy, retinopathy and nephropathy has been founded in 74 T2 DM patients with QTc>440 Ms.
By Pearson correlation, we found QTc interval significantly correlated with diabetes duration, Diastolic BP, TC , LDL-C and UACR., also by using multiple regression analysis we found LDL-c, diabetic duration and UACR were statistically significant predictors of QTc interval.
In logistic regression analysis for identification of risk factors for QTC interval prolongation, only LDL-c and UACR were statistically significant (P value<0.05) predictors of QTc interval.
Conclusion: Prolonged QTc prevalence among type 2 diabetic Egyptian patients was 33.6%. Although QTc prolongation was associated with longer diabetes duration, diastolic BP, total cholesterol, LDL-C, albumin urinary excretion, insulin therapy and retinopathy, only statistically significant predictors of QTc interval main risk factor for QTc prolongation were LDL-c and UACR.
Keyword: QTc; Bazett’s formula; Type 2 DM; Egyptian
References
1. Roger VL, Go AS, Lloyd-Jones DM, et al.; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statisticsd2012 update: a report from the American Heart Association. Circulation 2012;125:e2–e220.
2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34(Suppl. 1):S62–S69.
3. Cox AJ1, Azeem A, Yeboah J et al. Heart rate-corrected QT interval is an independent predictor of all-cause and cardiovascular mortality in individuals with type 2 diabetes: the Diabetes Heart Study.Diabetes Care. 2014 May; 37(5):1454-61. doi: 10.2337/dc13-1257.
4. Regidor E, Franch J, Segu´ı M, et al. Traditional risk factors alone could not explain the excess mortality in patients with diabetes: a national cohort study of older Spanish adults. Diabetes Care 2012; 35:2503–2509.
5. Schouten EG, Dekker JM, Meppelink P, et al. QT interval prolongation predicts cardiovascular mortality in an apparently healthy population. Circulation 1991; 84: 1516–1523.
6. P. M. Okin, R. B. Devereux, E. T. Lee, et al: “Electrocardiographic repolarization complexity and abnormality predict all-cause and cardiovascular mortality in diabetes: the strong heart study,” Diabetes, vol. 2004.53, no. 2, pp. 434–440.
7. M. Veglio, G. Bruno, M. Borra et al., “Prevalence of increased QT interval duration and dispersion in type 2 diabetic patients and its relationship with coronary heart disease: a population-based cohort,” Journal of Internal Medicine, 2002,vol. 251, no. 4, pp. 317–324.
8. H. D. Bazett, “An analysis of the time relations of electrocardiograms,” Heart, 1920, vol. 7, pp. 353–370.
9. M. Veglio, G. Bruno, M. Borra et al., “Prevalence of increased QT interval duration and dispersion in type 2 diabetic patients and its relationship with coronary heart disease: a population-based cohort,” Journal of Internal Medicine, 2002, vol. 251, no. 4, pp. 317–324.
10. Li X, Ren H, Xu Z, et al. Prevalence and risk factors of prolonged QTc interval among Chinese patients with type 2 diabetes. Exp Diabetes Res 2012; 2012: 234084.
11. M. Veglio, S. Giunti, L. K. Stevens, et al “Prevalence of Q-T interval dispersion in type 1 diabetes and its relation with cardiac ischemia: the EURODIAB IDDM complications study group,” Diabetes Care, vol. 25, no. 4, pp. 702–707, 2002.
12. Stern K, Cho YH, Benitez-Aguirre, et al ; QT interval, corrected for heart rate, is associated with HbA1c concentration and autonomic function in diabetes. Diabet Med. 2016 Jan 29. doi: 10.1111/dme.13085.
13. Hashimoto Y, Tanaka M, Senmaru T et al ; Heart rate-corrected QT interval is a novel risk marker for the progression of albuminuria in people with Type 2 diabetes. Diabet Med. 2015 Sep;32(9): 1221-6. doi: 10.1111/dme.12728.
14. Stehouwer CD, Gall MA, Twisk JW, et al. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes 2002; 51: 1157–1165.
15. Watabe D, Hashimoto J, Hatanaka R, HanazawaT,et al. Electrocardiographic left ventricular hypertrophy and arterial stiffness: the Ohasama study. Am J Hypertens 2006; 19: 1199–1205.
16. Asbury AK, Genuth SM, Griffin J et al. Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy: American Diabetes Association and American Academy of Neurology (Consensus Statement). Diabet Care. 1988 ; 11:592–597
17. N. K. Subbalakshmi, P. M. Adhikari, K. N. Sathyanarayana Rao, and P. S. Jeganathan, “Influencing factors of QTc among the clinical characteristics in type 2 diabetes mellitus,” Diabetes Research and Clinical Practice, 2010, vol. 88, no. 3, pp. 265–272.
18. K. Takebayashi, R. Naruse, K. Morita, et al, “The effect of insulin therapy and plasma glucose levels on corrected QT intervals in patients with type 2 diabetes,” Journal of Clinical Medicine and Research, 2012, vol. 4, pp. 1–5.
19. T. Kazumi, A. Kawaguchi, J. I. Katoh, Y. Ikeda, K. Kishi, and G. Yoshino, “Fasting serum insulin concentrations are associated with QTc duration independent of serum leptin, percent body fat, and BMI,” Diabetes Care,1999, vol. 22, no. 11, pp. 1917–1918.
20. H. C. Gerstein, M. E. Miller, R. P. Byington et al., “Effects of intensive glucose lowering in type 2 diabetes,” The New England Journal of Medicine, vol. 358, no. 24, pp. 2545–2559, 2008.
21. Gastaldelli, M. Emdin, F. Conforti, S. Camastra, and E. Ferrannini, “Insulin prolongs the QTc interval in humans,” American Journal of Physiology—Regulatory Integrative and Comparative Physiology, 2000, vol. 279, no. 6, pp. R2022–R2025.
22. vanNoord, M. C. J. M. Sturkenboom, S. M. J. M. Straus et al., “Serum glucose and insulin are associated with QTc and RR intervals in nondiabetic elderly,” European Journal of Endocrinology, 2010, vol. 162, no. 2, pp. 241–248.
23. S. M. A. Sohaib, O. Papacosta, R. W. Morris, P. W. Macfarlane, and P. H. Whincup, “Length of the QT interval: determinants and prognostic implications in a population-based prospective study of older men,” Journal of Electrocardiology, 2008, vol. 41, no. 6, pp. 704–710.
24. Surawicz B, Knoebel SB. Long QT: good, bad or indifferent? J Am CollCardiol 1984; 4: 398–413.
25. Veglio M, Bruno G, Borra M, Macchia G, Bargero G, D'Errico N et al. 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 Apr;251(4):317-24.