TOPLINE:
In patients with type 2 diabetes (T2D) of less than 10 years’ duration who were taking metformin monotherapy, ECG abnormalities — including evidence of cardiovascular autonomic neuropathy — were common and associated with cardiovascular risk factors. After adding one of four frequently used glucose-lowering agents to metformin, fewer major ECG changes occurred with liraglutide than with the other treatments.
METHODOLOGY:
- Researchers aimed to examine ECG abnormalities and cardiovascular autonomic neuropathy across the different glucose-lowering treatment groups in 5029 participants (mean age, 57.2 years; diabetes duration, 4.2 years; A1c level, 7.5%; 36.4% women) from the GRADE trial.
- The participants had T2D for less than 10 years and were initially taking metformin monotherapy before being randomly assigned to receive metformin plus one of four commonly used glucose-lowering agents (insulin glargine, glimepiride, liraglutide, or sitagliptin).
- Patients were followed up for an average of 5 years.
- Resting ECGs were recorded at baseline and at 2‐ and 4‐year follow-ups and analyzed for overall, major, and minor abnormalities, as well as heart rate variability — a measure of cardiovascular autonomic neuropathy.
TAKEAWAY:
- More than half of participants in the GRADE trial had ECG abnormalities (57.1%) and ECG-defined cardiovascular autonomic neuropathy (52.8%) at baseline. The presence of these abnormalities was associated with longer diabetes duration, higher systolic blood pressure, greater prevalence of hyperlipidemia, more frequent use of lipid-lowering treatment, and beta-blocker use.
- Major ECG abnormalities occurred less frequently in the liraglutide group than in the other treatment groups (9% vs 13% at 4 years).
- Researchers found no significant differences in ECG-defined cardiovascular autonomic neuropathy between the liraglutide and non-liraglutide groups at 2 and 4 years (P = .42).
IN PRACTICE:
“ECG abnormalities, including those of CAN [cardiovascular autonomic neuropathy], are common in T2D < 10 years and are associated with certain CV [cardiovascular] risk factors. The development of major ECG abnormalities may differ by glucose-lowering treatment, as fewer occurred with liraglutide vs the other treatments,” the authors concluded.
SOURCE:
The study was led by Rodica Pop-Busui, MD, PhD, Oregon Health & Science University in Portland. The results were presented on June 20 at the American Diabetes Association (ADA) 85th Scientific Sessions held June 20-23 at the McCormick Place Convention Center in Chicago, Illinois.
LIMITATIONS:
This abstract did not discuss any limitations.
DISCLOSURES:
Some authors disclosed receiving research support, consulting fees; serving on boards, advisory panels; being stock/shareholders; or other relationships with pharmaceutical and diagnostics companies and institutions.