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Predictors of electrocardiographic abnormalities in type 1 Diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy

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Abstract

Purpose

To determine the incidence and determinants of developing abnormalities on the 12-lead electrocardiogram (ECG) in persons with type 1 diabetes.

Methods

We evaluated the distribution of ECG abnormalities and risk factors for developing new abnormalities in 266 (mean age = 44 years ± 9.0; 50 % female) people with type 1 diabetes from the Wisconsin Epidemiologic Study of Diabetic Retinopathy. This analysis included participants with complete ECG data from study visit 5 (2000–2001) and follow-up ECGs from study visit 7 (2012–2014). ECG abnormalities were classified as major and minor according to Minnesota Code Classification.

Results

At baseline, 94 (35 %) participants had at least one ECG abnormality, including 13 major ECG abnormalities. At follow-up, 117 (44 %) participants developed at least one new ECG abnormality, including 35 new major ECG abnormalities. In a multivariable logistic regression model, older age (per 5-year increase: OR = 1.31, 95 % CI = 1.08, 1.60) was associated with the development of at least one new ECG abnormality, while serum HDL cholesterol (per 10-unit increase: OR = 0.98, 95 % CI = 0.96, 1.00) was protective against developing new ECG abnormalities.

Conclusions

The development of new ECG abnormalities is common in type 1 diabetes. Older age and HDL cholesterol are independent risk factors for developing new ECG abnormalities. Further research is needed to determine whether routine ECG screening is indicated in people with type 1 diabetes to identify those with underlying subclinical coronary heart disease.

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Acknowledgments

The authors would like to thank Jennifer Dreyer and Lorraine Danforth for their assistance with the collection and management of electrocardiogram data in the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

Funding

Drs. R. Klein and B. E. K. Klein were supported by grant HL59259 from the National Heart, Lung, and Blood Institute, grant EY016379 from the National Eye Institute, and an unrestricted grant from Research to Prevent Blindness, New York, New York. Dr. W. T. O’Neal is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number F32HL134290. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA, 30322, USA

    Wesley T. O’Neal

  2. Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Kristine E. Lee, Ronald Klein & Barbara E. K. Klein

  3. Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Elsayed Z. Soliman

  4. Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Elsayed Z. Soliman

Authors
  1. Wesley T. O’Neal
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  2. Kristine E. Lee
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  4. Ronald Klein
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  5. Barbara E. K. Klein
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Correspondence to Wesley T. O’Neal.

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The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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O’Neal, W.T., Lee, K.E., Soliman, E.Z. et al. Predictors of electrocardiographic abnormalities in type 1 Diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. J Endocrinol Invest 40, 313–318 (2017). https://doi.org/10.1007/s40618-016-0564-z

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  • DOI: https://doi.org/10.1007/s40618-016-0564-z

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