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High prevalence of prolonged QTc interval among individuals in ambulatory diabetic care in southwestern Uganda

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Abstract

Background

Heart rate-corrected QT (QTc) interval is associated with increased risk for cardiovascular events and mortality among individuals with diabetes mellitus (DM). Little is known about the epidemiology of prolonged QTc among people with DM in resource-limited settings.

Methods

We conducted a cross-sectional study among adults with diabetes in ambulatory care at the Mbarara Regional Referral Hospital, from November 2018 to April 2019. Twelve-lead ECG recordings were performed on all participants. We collected clinical and laboratory data related to diabetes disease status and treatment control. We estimated QTc using Bazett’s formula and categorized it according to standardized sex-adjusted thresholds. Linear regression analysis was performed to identify correlates of QTc.

Results

We recruited 299 participants with a mean age of 50.1 years (SD±9.8) and mean HbA1c of 9.7 % (SD±2.6), and 69.6% were female. We detected prolonged and borderline QTc in 6.4% (19/299, 95% CI: 3.9–9.7%) and 23.4% (70/299, 95% CI: 18.7–28.6%) of participants, respectively. In multivariate models, factors associated with increasing QTc interval were mean arterial pressure (β=0.34; 95% CI: 0.07–0.63, p=0.019) and female sex (β=15.26; 95% CI: 7.58–22.94, p<0.001).

Conclusions

The prevalence of abnormal QTc among individuals in routine diabetes care in southwestern Uganda was high. Female sex and mean arterial pressure were correlated with QTc interval. Given these findings, future studies should explore the clinical impact of abnormal QTc in this patient population.

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Acknowledgment

We thank the study participants, the staff, and management of the Mbarara Regional Referral Hospital who contributed in several ways towards the success of this study. We are very thankful to members of the Technical Advisory Committee (TAC) of the Mbarara University Research Training Initiative (MURTI) for their technical input into the study. We also acknowledge Dr. Sam Ruvuma and Dr. Kwagga Teddy of the Ophthalmology Department of the Mbarara University of Science and Technology for their technical support.

Availability of data and materials

The datasets generated and analyzed during the study are available from the corresponding author on request.

Funding

This research was supported by the Fogarty International Center and co-founding partners (NIH Common Fund, Office of Strategic Coordination, Office of the Director (OD/OSC/CF/NIH); Office of AIDS Research, Office of the Director (OAR/NIH); National Institute of Mental Health (NIMH/NIH); and National Institute of Neurological Disorders and Stroke (NINDS/NIH)) of the National Institutes of Health under Award Number D43TW010128.

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Authors and Affiliations

  1. Department of Physiology, Mbarara University of Science and Technology, Mbarara, P.O Box 1410, Uganda

    Richard Migisha, David Collins Agaba & Silvia Lopez Miranda

  2. Department of Physiology, King Ceasor University, Kampala, Uganda

    Godfrey Katamba

  3. Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

    Anthony Muyingo & Mark J. Siedner

  4. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Mark J. Siedner

Authors
  1. Richard Migisha
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  2. David Collins Agaba
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  3. Godfrey Katamba
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  4. Silvia Lopez Miranda
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  5. Anthony Muyingo
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  6. Mark J. Siedner
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Contributions

R.M., A.M., D.C.A, S.L.M, and M.S conceived the study, contributed to discussion, and reviewed, edited, and wrote the manuscript. G.K. and D.C.A. reviewed the ECG recordings. R.M and M.S. analyzed the data. R.M. is the guarantor of this research work and, as such, had full access to all the data for the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Richard Migisha.

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Ethics approval and consent to participate

The study got an approval from the institutional ethics review board of the Mbarara University of Science and Technology (MUST-REC). We also received approval for the study from the Uganda National Council of Science and Technology (UNCST) and from the Research Secretariat in the Office of the President of Uganda, in accordance with the national guidelines. All study participants provided written informed consent before recruitment and participation. Participants who could not write gave consent with a thumbprint.

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The authors declare no competing interests.

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Migisha, R., Agaba, D.C., Katamba, G. et al. High prevalence of prolonged QTc interval among individuals in ambulatory diabetic care in southwestern Uganda. Int J Diabetes Dev Ctries 41, 614–620 (2021). https://doi.org/10.1007/s13410-021-00944-6

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  • DOI: https://doi.org/10.1007/s13410-021-00944-6

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