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Autonomic neuropathy, QT interval lengthening, and unexpected deaths in male diabetic patients


QT intervals were measured over RR intervals ranging from 500 ms to 1000 ms in 13 normal male subjects, 13 male diabetic subjects without and 13 with autonomic neuropathy. There was a close linear relationship between QT and RR in all subjects. The slope of the regression line was significantly greater in the autonomic neuropathy group than the normal group. Thirty-two male diabetic subjects with varying degrees of autonomic dysfunction had repeat QT measurements 3 (range 2–6) years later. QT and QTC lengthened significantly at the second visit, unrelated to age or time between recordings, but which corresponded with changes in autonomic function. Of 71 male diabetic subjects under 60 years followed for 3 years, 13 had died, 8 unexpectedly. Of those with autonomic neuropathy, QT and QTC were significantly longer in those who subsequently died, despite similar ages and duration of diabetes. We conclude that QT/RR interval relationships are altered in diabetic autonomic neuropathy, and that changes in QT length with time parallel changese in autonomic function. There may be an association between QT interval prolongation and the risk of dying unexpectedly in diabetic autonomic neuropathy.


  1. 1.

    Ewing DJ, Clarke BF (1986) Autonomic neuropathy: its diagnosis and prognosis. Clin Endocrinol Metab 15: 855–888

  2. 2.

    Kahn JK, Sisson JC, Vinik AI (1987) QT interval prolongation and sudden cardiac death in diabetic autonomic neuropathy. J Clin Endocrinol Metab 64: 751–754

  3. 3.

    Bellavere F, Ferri M, Guarini L, Bax G, Piccoli A, Cardone C, Fedele D (1988) Prolonged QT period in diabetic autonomic neuropathy: a possible role in sudden cardiac death? Br Heart J 59: 379–383

  4. 4.

    Ewing DJ, Neilson JMM (1990) QT interval length and diabetic autonomic neuropathy. Diabetic Med 7: 23–26

  5. 5.

    Gonin JM, Kadrofske MM, Schmaltz S, Bastyr EJ, Vinik AI (1990) Corrected Q-T interval prolongation as diagnostic tool for assessment of cardiac autonomic neuropathy in diabetes mellitus. Diabetes Care 13: 68–71

  6. 6.

    Chambers JB, Sampson MJ, Sprigings DC, Jackson G (1990) QT prolongation on the electrocardiogram in diabetic autonomic neuropathy. Diabetic Med 7: 105–110

  7. 7.

    Schwartz PJ (1984) Sympathetic imbalance and cardiac arrhythmias. In: Randall WC (ed) Nervous control of cardiovascular function. Oxford University Press, New York Oxford, pp 225–252

  8. 8.

    Ewing DJ, Martyn CN, Young RJ, Clarke BF (1985) The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 8: 491–498

  9. 9.

    Ewing DJ, Neilson JMM, Travis P (1984) New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms. Br Heart J 52: 396–402

  10. 10.

    Cowan JC, Yusoff K, Moore M, Amos PA, Gold A, Bourke JP, Transuphaswadikul S, Campbell RWF (1988) Importance of lead selection in QT interval measurements. Am J Cardiol 61: 83–87

  11. 11.

    Ward DE (1988) Prolongation of the QT interval as an indicator of risk of a cardiac event. Eur Heart J 9 [Suppl G]: 139–144

  12. 12.

    Jermendy G, Toth L, Voros P, Koltai MZ, Pogatsa G (1990) QT interval in diabetic autonomic neuropathy. Diabetic Med 7: 750

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Ewing, D.J., Boland, O., Neilson, J.M.M. et al. Autonomic neuropathy, QT interval lengthening, and unexpected deaths in male diabetic patients. Diabetologia 34, 182–185 (1991). https://doi.org/10.1007/BF00418273

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Key words

  • Diabetes mellitus
  • autonomic neuropathy
  • QT interval
  • sudden death
  • autonomic function tests