Associations of Electrocardiographic Abnormalities in Stable Type 2 Diabetes Subjects: Experience from a Tertiary Health Facility in South Eastern Nigeria
Abstract
Introduction: Cardiovascular abnormalities are prevalent in the setting of diabetes mellitus, even among stable subjects, necessitating the need for a regular cardiovascular disease screening for this group of patients. Electrocardiogram is a simple and reliable screening test for cardiovascular abnormalities that could be easily accessible even in resource poor and rural settings. This study was carried out to determine the association between cardiovascular risk factors and electrocardiographic abnormalities in stable type 2 diabetes subjects in South Eastern Nigeria.
Materials and Methods: One hundred and thirty-six stable adults with type 2 diabetes mellitus were recruited consecutively from the out-patient diabetes clinic of Nnamdi Azikiwe University Teaching Hospital in South Eastern Nigeria. They were assessed for the risk factors for cardiovascular diseases that included smoking, obesity, dyslipidaemia, poor glycaemic control, hypertension, lack of exercise, presence of chronic kidney disease and metabolic syndrome. They also had a 12 lead electrocardiogram done. Results were analyzed using SPSS version 25. P value of ˂ 0.05 was considered significant.
Result: A total of 128 subjects had complete results and were analyzed. There were 63 males and 65 females with a mean age of 58.43 ± 12.85 years and mean diabetes duration of 9.03 ± 7.36 years. A total of 45.3% of the subjects had electrocardiographic abnormalities. Hypertension was present in 54.9%, dyslipidaemia in 91.4%, central obesity in 74.3%, metabolic syndrome in 76.6% and chronic kidney disease in 57.9% of the subjects. Significant association was found between smoking and occurrence of AV block (p = 0.008), central obesity and QRS axis abnormality (p = 0.002), dyslipidaemia and ST segment abnormality (p = 0.001) and lack of exercise and ST segment abnormality (p = 0.000). No significant association was found between age, sex of the subjects, duration of DM, treatment modality for DM, level of glycaemic control, hypertension, presence of CKD and metabolic syndrome and any of the electrocardiographic abnormalities.
Conclusion: Electrocardiographic abnormalities are common in stable type 2 diabetic subjects. There was significant association between smoking habit, central obesity, dyslipidaemia, lack of exercise and ECG abnormalities that included AV block, QRS axis and ST segment abnormalities.
Keywords:
Electrocardiographic abnormalities, stable type 2 diabetes subjects, cardiovascular disease, NigeriaDOI
https://doi.org/10.22270/jddt.v13i11.6006References
Gregg EW, Cheng YJ, Srinivasan M, Lin J, Geiss LS, Albright AL et al. trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet. 2018. 16 ; 391(10138):2430 - 2440. https://doi.org/10.1016/S0140-6736(18)30314-3 PMid:29784146
Ezeude CM, Ijeoma UN, Oguejiofor OC, Young EE, Nwatu CB, Onyenekwe BM et al. Asymptomatic Cardiovascular Disorders in a Cohort of Clinically Stable Type 2 Diabetes Mellitus Patients in South Eastern Nigeria: A Cross Sectional Study. JAMMR. 2020; 32(14):58 - 66. https://doi.org/10.9734/jammr/2020/v32i1430590
Nazimek-Siewniak B, Moczulski D, Grzeszczak W. Risk of macrovascularand microvascular complications in type 2 diabetes: Results of longitudinal study design. J Diabetes Complications. 2002; 16 (4):271-276. https://doi.org/10.1016/S1056-8727(01)00184-2 PMid:12126785
Kuzu F. The effect of type 2 diabetes on electrocardiographic markers of significant cardiac event. Pak J Med Sci. 2018; 34(3)626-632. https://doi.org/10.12669/pjms.343.14562 PMid:30034428 PMCid:PMC6041533
Dweck M, Campbell IW, Miller D, Francis CM. Clinical aspect of Silent myocardial ischaemia with particular reference to diabetes mellitus. Br J Diabetes Vasc Dis. 2018; 9:110-116. https://doi.org/10.1177/1474651409105249
Prineas RJ, Crow RS, Blackburn H. The Minnesota Code Manual of Electrocardiographic Findings: Standards and Procedures for Measurement and Classification. Boston, Mass: Wright-PSG; 1982.
Bacci S, Villella M, Villella A, Langialonga T, Grilli M, Rauseo A et al. Screening for silent myocardial ischaemia in type 2 diabetic patients with additional atherogenic risk and accuracy of the exercise stress test. Eur J Endocrinol. 2002; 147: 649 - 654. https://doi.org/10.1530/eje.0.1470649 PMid:12444897
Harms PP, van der Heijden AA, Rutters F, Tan HL, Beulens JWJ, Nijpel G et al. Prevalence of ECG abnormalities in people with type 2 diabetes: The Hoorn Diabetes Care System Cohort. J Diabetes Complications. 2021; 25 (2): 107810. https://doi.org/10.1016/j.jdiacomp.2020.107810 PMid:33280986
Stern S, Sclarowsky S, The ECG in Diabetes Mellitus. Circulation. 2009; 120: 1633 - 1636. https://doi.org/10.1161/CIRCULATIONAHA.109.897496 PMid:19841309
International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Chin Pract. 2014; 104 (1): 1 - 52. https://doi.org/10.1016/j.diabres.2012.10.001 Mid:24508150
Simova I, Christov I, Bortolan G. A review on electrocardiographic changes in diabetic patients. Curr Diabetes Rev. 2015; 11(2): 103 - 6. https://doi.org/10.2174/1573399811666150113161417 PMid:25584936
Lee MK, Hank, Kim MK, Koh ES, Kim ES, Noam GE et al. Changes in Metabolic Syndrome and its components and the risk of type 2 diabetes: a nationwide cohort study. Sci Rep 2020; 10: 2 - 13. https://doi.org/10.1038/s41598-020-59203-z PMid:32047219 PMCid:PMC7012827
Fluckiger R, Woodtli T, Berger W. Quantitation of glycosylated haemoglobin by boronate affinity chromatography. Diabetes. 1984; 33: 73-76. https://doi.org/10.2337/diabetes.33.1.73 PMid:6690345
Mark V. An improved glucose oxidase method for determining blood, csf, urine glucose levels. Clin Chim Acta. 1996; 251: 19 - 24. https://doi.org/10.1016/0009-8981(96)83704-1 PMid:8814347
Hirano T, Nohtomi K, Koba S, Muroi A, Ito Y. A simple and precise method for measuring HDL-cholesterol subfractions by a single precipitation followed by homogenous HDL-cholesterol assay. J lipid Res. 2008; 49: 1130 - 1136. https://doi.org/10.1194/jlr.D700027-JLR200 PMid:18223297
Allain CC, Poon LS, Chan CSG, Richmond W, Fu C. Enzymatic determination of total serum cholesterol. Clin Chem. 1974; 20: 470 - 475. https://doi.org/10.1093/clinchem/20.4.470 PMid:4818200
Bucolo G, David H. Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem. 1973; 19: 476 - 482. https://doi.org/10.1093/clinchem/19.5.476 PMid:4703655
Assmann G, Jabs HU, Kohnert U, Nolte W, Schriewer H. LDL-cholesterol determination in blood serum following precipitation of LDL with polyvinylsulphate. Clin Chim Acta. 1984; 140: 77 - 83. https://doi.org/10.1016/0009-8981(84)90153-0 PMid:6744629
Toora BD, Rajagopal G. measurement of creatinine by Jaffe's reaction determination of concentration of sodium hydroxide required for maxmum color development in standard urine and protein free filtrate of serum. Indian J Exp Biol. 2002; 40 (3): 352 - 355. PMD12635710
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D et al. Modification of Diet in Renal Disease Study Group. A more accurate method to estimate glomerular prediction equation. Ann Intern Med. 1999; 130: 461 - 70. https://doi.org/10.7326/0003-4819-130-6-199903160-00002 PMid:10075613
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42: 1206 - 1252. https://doi.org/10.1161/01.HYP.0000107251.49515.c2 PMid:14656957
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. WHO/NCD/NCS 99. Geneva ; WHO, 1999; pp 1 - 58.
National Cholesterol Education Program. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP 111 Final Report). Circulation. 2022; 106: 3141 - 3421.
U.S. Census Bureau, 2012 Population Estimates and 2012 National Projections. https://www.Census.gov
Khanal MK, Bhandari P, Dhungana RR, Gurung Y, Rawal LB, Pandey G, Bhandari M, Bhuiyan R, Devkota S, de Courten M, de Courten B. Electrocardiogram abnormalities and renal impairment in patients with type 2 diabetes mellitus: A healthcare facilities-based cross-sectional study in Dang district of Nepal. J Diabetes Investig. 2023 Apr;14(4):602-613. https://doi.org/10.1111/jdi.13985 PMid:36747483 PMCid:PMC10034961
Sinamaw, D., Getnet, M., Abdulkadir, M. et al. Patterns and associated factors of electrocardiographic abnormality among type 2 diabetic patients in Amhara National Regional State Referral Hospitals, Ethiopia: a multicenter institution-based cross-sectional study. BMC Cardiovasc Disord 22, 230 (2022). https://doi.org/10.1186/s12872-022-02661-2 PMid:35590246 PMCid:PMC9118567
Bedane, D.A., Tadesse, S., Bariso, M. et al. Assessment of electrocardiogram abnormality and associated factors among apparently healthy adult type 2 diabetic patients on follow-up at Jimma Medical Center, Southwest Ethiopia: Cross-sectional study. BMC Cardiovasc Disord 21, 312 (2021). https://doi.org/10.1186/s12872-021-02110-6 PMid:34167465 PMCid:PMC8223340
Sellers MB, Divers J, Lu L, Xu J, Smith SC, Bowden DW et al. Prevalence and determinants of electrocardiographic abnormalities in African Americans with type diabetes. J Epidemol Glob Health. 2014; 4 (4): 289 - 296. https://doi.org/10.1016/j.jegh.2014.04.003 PMid:25455646 PMCid:PMC4254487
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. https://doi.org/10.7860/JCDR/2017/24882.9740 PMid:28571189 PMCid:PMC5449835
Mantovani A, Rigolon R, Turino T, Pichiri I, Falceri A, Rossi A, Temporelli PL, Bonapace S, Lippi G, Zoppini G, Bonora E, Byrne CD, Targher G. Association between decreasing estimated glomerular filtration rate and risk of cardiac conduction defects in patients with type 2 diabetes. Diabetes Metab. 2018 Dec;44(6):473-481. https://doi.org/10.1016/j.diabet.2018.08.007 PMid:30195089
Chang YK, Fan HC, Hsu CC, Lim PS. The association between EKG abnormalities and the development of microalbuminuria in type 2 diabetes. Medicine (Baltimore). 2021 Dec 23;100(51):e28018. https://doi.org/10.1097/MD.0000000000028018 PMid:34941042 PMCid:PMC8702232
Published



How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).