QTc Interval Prolongation and Its Association with Albuminuria Severity in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
DOI:
https://doi.org/10.55489/njmr.160420261369Keywords:
QTc Interval, Albuminuria, Diabetes Mellitus Type 2, Cardiac Autonomic Neuropathy, Diabetic Nephropathy, Cardiovascular RiskAbstract
Background: Type 2 Diabetes Mellitus (T2DM) is associated with multiple microvascular complications, including diabetic nephropathy and cardiac autonomic dysfunction. Prolongation of the corrected QT (QTc) interval has emerged as a potential marker of cardiovascular risk, while albuminuria reflects early renal involvement. This study aimed to evaluate the association between QTc interval prolongation and albuminuria severity in patients with T2DM.
Methods: A cross-sectional observational study was conducted among 100 patients with T2DM attending a tertiary care hospital. Clinical evaluation, laboratory investigations, urine albumin-to-creatinine ratio (UACR), and 12-lead electrocardiography were performed. Participants were categorized according to diabetes duration and UACR levels. Statistical analysis included independent Student’s t-test and one-way ANOVA, with p<0.05 considered statistically significant.
Results: The mean age of the participants was 60.12±12.14 years, and 62% were females. Diabetic neuropathy and retinopathy were present in 66% and 63% of patients, respectively. Patients with diabetes duration ≥5 years had significantly higher UACR (141.28±75.40 vs. 100.33±64.41 mg/g; p=0.004), QT interval (384.22 ± 44.66 vs. 349.96 ± 43.58 ms; p=0.019), and QTc interval (489.29 ± 51.40 vs. 454.98 ± 50.51 ms; p=0.024) compared to those with shorter disease duration. A significant increase in HbA1c (p=0.005) and QTc interval (p=0.013) was observed across increasing UACR categories, indicating a dose-dependent relationship between albuminuria severity and cardiac repolarization abnormalities.
Conclusion: QTc interval prolongation is significantly associated with increasing albuminuria severity, poor glycemic control, and longer diabetes duration. QTc assessment may serve as a simple, non-invasive marker for identifying T2DM patients at increased risk of microvascular and cardiovascular complications.
References
1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. DOI: https://doi.org/10.1016/j.diabres.2021.109119. Erratum in: Diabetes Res Clin Pract. 2023 Oct;204:110945. DOI: https://doi.org/10.1016/j.diabres.2023.110945. PMID: 34879977 PMCID: PMC11057359
2. Feldman EL, Nave KA, Jensen TS, Bennett DL. New horizons in diabetic neuropathy: mechanisms, bioenergetics, and pain. Neuron. 2017;93(6):1296-1313. DOI: https://doi.org/10.1016/j.neuron.2017.02.005 PMid:28334605 PMCid:PMC5400015
3. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. New England Journal of Medicine. 1984;310(6):356-360. DOI: https://doi.org/10.1056/NEJM198402093100605 PMid:6690964
4. Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-830. DOI: https://doi.org/10.7326/0003-4819-158-11-201306040-00007 PMid:23732715
5. Parving HH, Oxenbøll B, Svendsen PA, Christiansen JS, Andersen AR. Early detection of patients at risk of developing diabetic nephropathy. A longitudinal study of urinary albumin excretion. Acta Endocrinol (Copenh). 1982;100(4):550-555. DOI: https://doi.org/10.1530/acta.0.1000550 PMid:6812342
6. Kobayashi S, Nagao M, Asai A, Fukuda I, Oikawa S, Sugihara H. Severity and multiplicity of microvascular complications are associated with QT interval prolongation in patients with type 2 diabetes. J Diabetes Investig. 2018;9(4):946-951. DOI: https://doi.org/10.1111/jdi.12772 PMid:29095573 PMCid:PMC6031516
7. Schwartz PJ, Ackerman MJ. The long QT syndrome: a transatlantic clinical approach to diagnosis and therapy. Eur Heart J. 2013;34(40):3109-3116. DOI: https://doi.org/10.1093/eurheartj/eht089 PMid:23509228
8. Dominic SK, Henry RA, Kartha N, Pillai G. The Association Between Microalbuminuria and QTc Prolongation in Patients with Type 2 Diabetes Mellitus: A Single-Centre Study from South India. Cureus. 2023;15(3):e35646. DOI: https://doi.org/10.7759/cureus.35646 PMid:37009348 PMCid:PMC10065364
9. Burkett E, Keijzers G, Lind J. The relationship between blood glucose level and QTc duration in the critically ill. Crit Care Resusc. 2009;11(1):8-13. DOI: https://doi.org/10.1016/S1441-2772(23)01839-2 PMid:19281438
10. Mehta N, Kandulna AK, Kantibhai SS, Dhol SB, Kapadiya SB, Gupta M. The evaluation of QTc prolongation and QT dispersion in type 2 diabetes mellitus as an indicator of cardiac autonomic neuropathy. European Journal of Cardiovascular Medicine. 2025;15:448-451.
11. Ninkovic VM, Ninkovic SM, Miloradovic V, Stanojevic D, Babic M, Giga V, et al. Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes. Acta Diabetol. 2016;53(5):737-744. DOI: https://doi.org/10.1007/s00592-016-0864-y PMid:27107571 PMCid:PMC5014905
12. American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Suppl 1):S17-S38. DOI: https://doi.org/10.2337/dc22-S002 PMid:34964875
13. Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R, Deal BJ, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53(11):982-991. DOI: https://doi.org/10.1016/j.jacc.2008.12.014 PMid:19281931
14. Sawarthia S, Patel R, Patil PP. A Cross-Sectional Study to Determine the Association of Corrected QT Interval with Microalbuminuria in Type 2 Diabetes Mellitus. Cureus. 2023;15(5):e38967. DOI: https://doi.org/10.7759/cureus.38967 PMID: 37313082 PMCID: PMC10260269
15. Stern K, Cho YH, Benitez-Aguirre P, Jenkins AJ, McGill M, Mitchell P, et al. QT interval, corrected for heart rate, is associated with HbA1c concentration and autonomic function in diabetes. Diabet Med. 2016;33(10):1415-1421. DOI: https://doi.org/10.1111/dme.13085 PMid:26823095
16. Rutter MK, Viswanath S, McComb JM, Kesteven P, Marshall SM. QT prolongation in patients with Type 2 diabetes and microalbuminuria. Clin Auton Res. 2002;12(5):366-372. DOI: https://doi.org/10.1007/s10286-002-0036-8 PMid:12420081
17. Psallas M, Tentolouris N, Papadogiannis D, Doulgerakis D, Kokkinos A, Cokkinos DV, et al. QT dispersion: comparison between participants with Type 1 and 2 diabetes and association with microalbuminuria in diabetes. J Diabetes Complications. 2006;20(2):88-97. DOI: https://doi.org/10.1016/j.jdiacomp.2005.05.012 PMid:16504837
18. Hashimoto Y, Tanaka M, Senmaru T, Okada H, Hamaguchi M, Asano M, et al. Heart rate-corrected QT interval is a novel risk marker for the progression of albuminuria in people with Type 2 diabetes. Diabet Med. 2015;32(9):1221-1226. DOI: https://doi.org/10.1111/dme.12728 PMid:25683576
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sahil, Jasmine Kaur, Raman Kumar Sharma, Aneesha Chibber, Akash Bawa, Prabhjot Kaur Gill
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Author/s retain the copyright of their article, with first publication rights granted to Medsci Publications.
