Electrocardiographic Changes in Patients with Type 2 Diabetes Mellitus—A Meta-Analysis
Simple Summary
Abstract
1. Introduction
2. Objective
3. Materials and Methods
- Initially, a simple search was conducted using the terms “diabetes electrocardiogram” and “diabetes electrocardiography”.
- Using MeSH, “diabetes” was entered, and “electrocardiogram changes OR electrocardiographic changes” was selected. Filters such as publication period, study type, and target population were applied.
- Keywords such as “diabetes”, “electrocardiogram”, “changes”, “complications”, “cardiovascular”, and “disease” were combined using operators like OR, AND, and NOT.
- A final comprehensive search was conducted using all the selected keywords and filters.
3.1. Inclusion and Exclusion Criteria
- Were published before 2017;
- Were clinical case reports or trials;
- Focused on patients with type 1 diabetes;
- Were written in languages other than English;
- Provided insufficient data for analysis;
- Were not observational in nature;
- Involved patients who had electrocardiographic abnormalities diagnosed before their diabetes diagnosis;
- Did not adhere to high research standards or presented a high risk of bias.
3.2. Data Extraction
3.3. Statistical Analysis
4. Results
4.1. Sensitivity Analysis: Exploration of Heterogeneity
4.2. Included Studies
4.3. Narrative Summary
4.4. Quantitative Summary
4.5. Major Electrocardiographic Changes
4.6. fQRS Complex Changes
4.7. Prolonged QTc Interval Changes
5. Discussions
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Study | Author | Year of Publication | Study Type | Characteristics of Studied Subjects | Number of Patients | Type of Intervention | Followed Effect |
---|---|---|---|---|---|---|---|
1 | Harms et al. [18] | 2021 | Cohort | Average age: 67.7 ± 11.0 Male sex: 55.6% Female sex: 44.4% | 8068 Participants without a history of cardiovascular diseases: 6494 | Electrocardiogram abnormalities were defined using the Minnesota classification. These were classified into different types of abnormalities (minor and major electrocardiogram abnormalities). | Electrocardiogram abnormalities were very commonly found in the population with type II diabetes, including among those without a history of cardiovascular diseases. Among patients with diabetes diagnosed for more than 10 years, the prevalence was of 48.8% minor abnormalities and 48.9% significant abnormalities. |
2 | Kersten et al. [19] | 2021 | Cohort | Average age: 57 ± 16 Male sex: 41% Female sex: 59% | 517 | The electrocardiograms were performed using the Nihon Kohden Cardiofax V Electrocardiograph ECG-1550A (Nihon Kohden, Shinjuku, Japan) and were interpreted using the ECAPS 12C software. | It was found that the appearance of electrocardiographic abnormalities in the context of advanced age, coronary artery disease, or diabetes mellitus is very likely to be accompanied by changes in echocardiography. |
3 | Abiodun et al. [20] | 2019 | Cross-sectional | Average age: 53.72 ± 15.2 Male sex: 51.7% Female sex: 48.3% | 491 | An electrocardiogram was performed. An assessment of the risk of metabolic syndrome in the cardiovascular system was conducted. Questionnaires were used to collect data about the patients. | There was a high prevalence of metabolic syndrome and the occurrence of electrocardiographic changes in the studied population. Electrocardiogram abnormalities appeared more frequently in the male population, with no significant difference between those with or without metabolic syndrome. |
4 | Bedane et al. [21] | 2021 | Cross-sectional | Average age: 53.34 ± 11.07 Male sex: 61% Female sex: 39% | 344 | A standard twelve-lead electrocardiogram was performed. | Most of the studied population had electrocardiographic abnormalities (3 out of 5). Factors such as a duration of diabetes of more than 10 years or the use of solid oils were associated with the appearance of abnormalities on electrocardiography. |
5 | Goncalves et al. [22] | 2021 | Cross-sectional | Average age: 35.0 ± 14.5 Male sex: 37% Female sex: 63% | 2379 | A standard twelve-lead electrocardiogram was performed on all patients and then coded using the Minnesota classification. | Minor electrocardiographic abnormalities were more frequently observed in the male population, while significant abnormalities were more common in the female population. The prevalence was as follows: 22.3% minor abnormalities and 4.58% significant abnormalities. |
6 | Sardesai et al. [23] | 2022 | Cross-sectional | Average age: 56.3 ± 8.60 Male sex: 58.5% Female sex: 41.5% | 130 | The results of the electrocardiogram and 2D echocardiography were correlated with blood glucose levels. | Electrocardiogram abnormalities were strongly correlated with postprandial glucose levels, while they were not correlated with fasting glucose levels. |
7 | Sinamaw et al. [24] | 2021 | Cross-sectional | Average age: 56.7 (±12.7, range = 28–80) Male sex: 51.55% Female sex: 48.45 | 258 | A digital electrocardiograph was used to measure electrocardiographic parameters, and other data were collected using a questionnaire. | Half of the patients had at least one change observed on the electrocardiogram. Factors such as the long duration of disease (type II diabetes), high postprandial glucose, or hypertension were associated with electrocardiographic abnormalities. |
8 | Yagi et al. [25] | 2021 | Cross-sectional | Average age: 51 ± 8 Male sex: 76% Female sex: 24% | 702 | An electrocardiogram was performed, and fQRS-type changes were sought. | fQRS-type changes were more frequently observed in patients with diabetes than in those with metabolic syndrome or the control group. |
9 | Yagi et al. [26] | 2022 | Cross-sectional | Average age: 67.3 ± 12.6 Male sex: 60.3% Female sex: 39.7% | 320 | An electrocardiogram was performed, and fQRS-type changes were sought to associate them with diastolic cardiac dysfunction in the context of diabetes mellitus. | The appearance of fQRS could be a promising predictor for the onset of diastolic cardiac dysfunction, but the results should be confirmed through a more extensive cohort study. |
10 | Fu et al. [27] | 2019 | Cross-sectional | Average age: 58.2 Male sex: 35.2% Female sex: 64.8% | 11488 | Each study participant completed a questionnaire and underwent a physical examination, blood collection for laboratory tests, electrocardiography, and other tests. | Increased blood glucose levels are highly prevalent in those over 35 years old and are associated with an increased prevalence of non-valvular atrial fibrillation. |
11 | Shi et al. [28] | 2020 | Cross-sectional | Average age: 52 Male sex: 70.11% Female sex: 29.88% | 358 | A standard twelve-lead electrocardiogram was performed to identify QTc. Tests were also performed to diagnose obstructive sleep apnea and then correlated with QTc changes. | The severity of obstructive sleep apnea was strongly correlated with QTc prolongation in 358 patients with type II diabetes. Factors such as advanced age, body mass index, and female sex are independent factors for the occurrence of obstructive sleep apnea or cardiovascular diseases. |
12 | Ukpabi et al. [29] | 2017 | Cross-sectional | Average age: 46.09 ± 9.51 Male sex: 49.43% Female sex: 50.56% | 176 | A control group of non-diabetic patients was included. Tests for cardiac autonomic function were performed to diagnose cardiac autonomic neuropathy. | The prevalence of prolonged QTc in patients with type II diabetes and cardiac autonomic neuropathy was 12%. |
13 | Migisha et al. [30] | 2021 | Cross-sectional | Average age: 50.1 years (SD ± 9.8) Male sex: 30.4% Female sex: 69.6% | 299 | A standard twelve-lead electrocardiogram was performed. A linear progression analysis was conducted to identify QTc correlations. | The prevalence of QTc abnormalities was very high. |
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Alexescu, T.-G.; Nechita, A.; Alexander, P.; Perné, M.-G.; Milaciu, M.-V.; Ciulei, G.; Para, I.; Negrean, V.; Chiș, A.-F.; Todea, D.-A.; et al. Electrocardiographic Changes in Patients with Type 2 Diabetes Mellitus—A Meta-Analysis. J. Mind Med. Sci. 2025, 12, 14. https://doi.org/10.3390/jmms12010014
Alexescu T-G, Nechita A, Alexander P, Perné M-G, Milaciu M-V, Ciulei G, Para I, Negrean V, Chiș A-F, Todea D-A, et al. Electrocardiographic Changes in Patients with Type 2 Diabetes Mellitus—A Meta-Analysis. Journal of Mind and Medical Sciences. 2025; 12(1):14. https://doi.org/10.3390/jmms12010014
Chicago/Turabian StyleAlexescu, Teodora-Gabriela, Antonia Nechita, Paula Alexander, Mirela-Georgiana Perné, Mircea-Vasile Milaciu, George Ciulei, Ioana Para, Vasile Negrean, Ana-Florica Chiș, Doina-Adina Todea, and et al. 2025. "Electrocardiographic Changes in Patients with Type 2 Diabetes Mellitus—A Meta-Analysis" Journal of Mind and Medical Sciences 12, no. 1: 14. https://doi.org/10.3390/jmms12010014
APA StyleAlexescu, T.-G., Nechita, A., Alexander, P., Perné, M.-G., Milaciu, M.-V., Ciulei, G., Para, I., Negrean, V., Chiș, A.-F., Todea, D.-A., Vălean, D., Țărmure, S.-F., & Orășan, O.-H. (2025). Electrocardiographic Changes in Patients with Type 2 Diabetes Mellitus—A Meta-Analysis. Journal of Mind and Medical Sciences, 12(1), 14. https://doi.org/10.3390/jmms12010014