Differences in Prevalence and Incidence of Electrocardiogram Abnormalities and Cardiovascular Autonomic Neuropathy Among Randomized Glucose-Lowering Treatments in Early Type 2 Diabetes: the Glycemia Reduction Approaches in Diabetes (GRADE) Cohort.

Details

• Alternative Title:
  Diabetes Care, 2025, v. 48, no. 11: Differences in Prevalence and Incidence of Electrocardiogram Abnormalities and Cardiovascular Autonomic Neuropathy Among Randomized Glucose-Lowering Treatments in Early Type 2 Diabetes: the Glycemia Reduction Approaches in Diabetes (GRADE) Cohort.
• Journal Article:
  Diabetes Care
• Personal Author:
  Pop-Busui, Rodica ; Rosin, Samuel P. ; Butera, Nicole M. ; Krause-Steinrauf, Heidi ; Assi, Hiba Abou ; Garg, Rajesh K. ; Inzucchi, Silvio E. ; Katona, Aimee ; McGill, Janet B. ; Mudaliar, Sunder ; Schade, David S. ; Seaquist, Elizabeth R. ; Tiktin, Margaret ; Soliman, Elsayed Z. ; Green, Jennifer B.
• Corporate Authors:
  for the GRADE Research Group
• Description:
  To describe the prevalence and incidence of electrocardiogram (ECG) abnormalities and ECG-derived cardiovascular autonomic neuropathy (CAN) in the GRADE cohort of adults with type 2 diabetes (T2D) <10 years.
  
  Individuals with T2D taking metformin alone were randomly assigned to add insulin glargine, glimepiride, liraglutide, or sitagliptin. Resting ECGs were completed at the baseline, 2-year, and 4-year study visits and analyzed for minor and major abnormalities and CAN assessed with heart rate variability (HRV) in 4,769 participants. Incidence of new major, minor, and any ECG abnormalities and CAN by treatment group was analyzed using logistic repeated-measures models at years 2 and 4 adjusted for baseline risk factors.
  
  At baseline, participants were a mean age of 57.2 ± 10.0 years, 36.3% were women, mean diabetes duration was 4.3 ± 2.8 years, and mean HbA1c was 7.5 ± 0.5%. Participants with ECG abnormalities at baseline (57.1%) and ECG-derived CAN (52.8%) were older and had more severe cardiovascular risk factors. The incidence of minor and major ECG abnormalities was similar among all treatment groups. However, at year 4, major ECG abnormalities were fewer in the liraglutide versus nonliraglutide groups (9% vs. 13%; P = 0.03). The incidence of CAN did not differ between the liraglutide and nonliraglutide groups across visits (P = 0.42); however, one measure of HRV (SD of normal-to-normal R-R intervals) was higher at year 2 in the liraglutide versus nonliraglutide groups (P = 0.02).
  
  ECG abnormalities, including those reflecting CAN, are common in individuals with T2D <10 years and more so in those with certain cardiovascular risk factors. The development of major ECG abnormalities may be lower with liraglutide.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Diabetes Mellitus, Type 2
  • Female
  • Middle Aged
  • Male
  • Electrocardiography
  • Hypoglycemic Agents
  • Liraglutide
  • Metformin
  • Sulfonylurea Compounds
  More +
• Keywords:
  • type 2 diabetes
  • electrocardiograms
  • heart rate variability
  • insulin
  • sulfonylurea
  • GLP-1 receptor agonist
  • DPP-4 inhibitor
• Source:
  Diabetes Care, 2025, v. 48, no. 11
• DOI:
  https://doi.org/10.2337/dc25-1087
• ISSN:
  0149-5992 ; 1935-5548
• Pubmed ID:
  40986645
• Pubmed Central ID:
  PMC12583396
• Document Type:
  Text
• Funding:
  UL1 TR000445/TR/NCATS NIH HHSUnited States/ ; U01DK098246/DK/NIDDK NIH HHSUnited States/ ; HL/NHLBI NIH HHSUnited States/ ; UL1 TR002529/TR/NCATS NIH HHSUnited States/ ; UL1 TR002369/TR/NCATS NIH HHSUnited States/ ; P30 DK020541/DK/NIDDK NIH HHSUnited States/ ; UL1 TR002378/TR/NCATS NIH HHSUnited States/ ; UM1 TR004528/TR/NCATS NIH HHSUnited States/ ; P30 DK020572/DK/NIDDK NIH HHSUnited States/ ; UL1 TR002243/TR/NCATS NIH HHSUnited States/ ; U34-DK-088043/DK/NIDDK NIH HHSUnited States/ ; UL1 TR002345/TR/NCATS NIH HHSUnited States/ ; UL1 TR002548/TR/NCATS NIH HHSUnited States/ ; U34 DK088043/DK/NIDDK NIH HHSUnited States/ ; UL1 TR002537/TR/NCATS NIH HHSUnited States/ ; P30 DK092926/DK/NIDDK NIH HHSUnited States/ ; American Diabetes Association/ ; UL1 TR002535/TR/NCATS NIH HHSUnited States/ ; P30 DK072476/DK/NIDDK NIH HHSUnited States/ ; P30 DK079626/DK/NIDDK NIH HHSUnited States/ ; UL1 TR001409/TR/NCATS NIH HHSUnited States/ ; U01 DK098246/DK/NIDDK NIH HHSUnited States/ ; UL1 TR001449/TR/NCATS NIH HHSUnited States/ ; UL1 TR002489/TR/NCATS NIH HHSUnited States/ ; U54 GM104940/GM/NIGMS NIH HHSUnited States/ ; UL1 TR001108/TR/NCATS NIH HHSUnited States/ ; P30 DK045735/DK/NIDDK NIH HHSUnited States/ ; UL1 TR000439/TR/NCATS NIH HHSUnited States/ ; P30 DK017047/DK/NIDDK NIH HHSUnited States/ ; CC/CDC HHSUnited States/
• Genre:
  Journal Article
• Pages in Document:
  1960-1970 (23 pdf pages)
• Volume:
  48
• Issue:
  11
• Download URL:
  https://stacks.cdc.gov/view/cdc/261040/cdc_261040_DS1.pdf
• File Type:
  [PDF - 862.46 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:9465361c7503bf03f888feafc1ab5a0e51b53cb8259585ebe4f99724b94e4fa15937667f2479e0f2f1af504bd01c954d8a3b6d6e312aa756998897abc1a7a86a