Published: 2020-02-26

Detailed ECG analysis in type 2 diabetes mellitus: a predictor of multitude of complications

Vijayashree Shrirang Gokhale, Manoj Prakash Jeyaseelan


Background: Type 2 diabetes mellitus is a systemic disease with life-threatening complications and morbidity. The 12 lead ECG, an easily available investigation, when studied in detail can give a lot of information and predict various microvascular and macrovascular complications apart from coronary artery disease.

Methods: A random cross sectional study involving 100 patients of type 2 diabetes mellitus, in the age group of 18-80 years were included in study after applying various inclusion and exclusion criteria. They were subjected to ECG, 2D echocardiography and laboratory tests. Data were collected and analysed.

Results: Arrythmia was not detected in any patient. A resting tachycardia (HR >100) in 30 patients correlated with Prolonged QTc (>440 miliseconds) (p=0.04). QRS amplitude was reduced in 26 patients. Prolonged QTc also correlated with presence of diabetic complications, retinopathy of NPDR type and nephropathy (p=0.004). Hence about 30% of the study group did show signs of early diabetic cardiac autonomic neuropathy and cardiomyopathy.

Conclusions: The statistically significant utility of electrocardiogram in predicting various complications of diabetes apart from coronary artery disease.


Diabetes mellitus, Diabetic cardiac autonomic neuropathy, QTc prolongation, Resting tachycardia

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Stern S, Sclarowsky S. The ECG in diabetes mellitus. Circulation. 2009;120:1633-6.

Amione C, Giunti S, Fornengo P, Sabita S. Incidence of prolonged QTc and severe hypoglycemia in type 1 diabetes. The EURODIAB prospective complications study. Acta Diabetol. 2017;54:871.

Giunti S, Bruno G, Lillaz E, Gruden G. Incidence and risk factors of prolonged QTc interval in type 1 diabetes. The EURODIAB prospective complications study diabetes care. 2007;30(8):2057-63.

Santiago A, Lledó GA, Ramos E, Santiago C. Prognostic value of ECGs in patients with type-2 diabetes mellitus without known cardiovascular disease. Rev Esp Cardiol. 2007;60(10):1035-41.

Nelson MR, Daniel KR, Carr JJ, Freedman BI, Prineas RJ, Bowden DW. Associations between electrocardiographic interval durations and coronary artery calcium scores: the diabetes heart study. Pacing Clin Electrophysiol. 2008;31(3):314-21.

Chugh SS, Reinier K, Singh T, Evanado A, Socoteneanu C, Peters D, et al. Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the oregon sudden unexpected death study. Circulation. 2009;119(5):663-70.

Okin PM, Devereux RB, Lee ET, Galloway JM, Howard BV. Electrocardiographic repolarization complexity and abnormality predict all-cause and cardiovascular mortality in diabetes: the strong heart study. Diabetes. 2004;53:434-40.

Seyerle A. Pharmacogenomics of Ventricular Conduction in Multi-Ethnic Populations. 2016. Available at Accessed on 26 September 2019.

Voulgari C, Tentolouris N, Stefanadis C. The ECG vertigo in diabetes and cardiac autonomic neuropathy. Exp Diabetes Res. 2011;20:68-76.

Franconi F, Campesi I, Occhioni S, Tonolo G. Sex-gender differences in diabetes vascular complications and treatment. Endocr Metab Immune Disord Drug Targets. 2012;12:179-96.

Gupta S, Gupta RK, Kulshrestha M, Chaudhary RR. Evaluation of ECG abnormalities in patients with asymptomatic type 2 diabetes mellitus. J Clin Diagn Res. 2017;11(4):39-41.

Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes. 2014;5(1):17-39.

Moscoso PAS, Esparza AS, Botero SM, Gomez JE. Diabetic cardiovascular autonomic neuropathy - an underestimated enemy. J Cardiol. 2016;14:17-9.

Serhiyenko VA, Serhiyenko AA. Diabetic cardiac autonomic neuropathy: Do we have any treatment perspectives? World J Diabetes. 2015;6(2):245-58.

Chang YC, Wu CC, Lin CC, Wu YW. Early myocardial repolarization heterogeneity is detected by magnetocardiography in diabetic patients with cardiovascular risk factors. PLos One. 2015;10:33-7.

Agarwal G, Singh SK. Arrhythmias in type 2 diabetes mellitus. Indian J Endocrinol Metabol. 2017;21(5):715-8.

X Yang, J Su, X Zhang, L Zhao, F Xu. The relationship between insulin sensitivity and heart rate-corrected QT interval in patients with type 2 diabetes. Diabetol Metab Syndr. 2017;9:69.

Balakrishnan VK, Devendiran S, Anand NN, Rajendran SM. Prevalence of heart disease among asymptomatic chronic type 2 diabetic patients. Int J Cardiovasc Res. 2017;6:4-8.

Patil VC, Patil HV, Shah KB, Vasani JD. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res. 2011;2:213-22.

Benichou T, Preira B, Mermilod M, Daniela P. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS One. 2006;13(4):19-26.

Moningi S, Nikhar S, Ramachandran G. Autonomic disturbances in diabetes: assessment and anaesthetic implications. Indian J Anaesth. 2018;62(8):575-83.

Negishi K. Echocardiographic feature of diabetic cardiomyopathy: where are we now? Cardiovasc Diagn Ther. 2018;8(1):47-56.