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How are Diabetes and Cardiovascular Disease Related?

Jul 24, 2021
Editor: Steve Freed, R.PH., CDE

Author: Oluwatayo Ishola, PharmD. Candidate, South College, School of Pharmacy

Major electrocardiogram abnormalities have been found in patients with type 2 diabetes, giving insight into how diabetes and cardiovascular disease are related. 

In a study conducted with approximately 8,000 diabetes patients, more than 13 percent were found to have significant abnormalities in their ECG readings. Sixteen percent of study participants exhibited minor abnormalities. Of the patient abnormalities discovered, arrhythmias made up 11 percent, and ventricular conduction defects made up 14 percent. Even more apparent than significant ECG abnormalities were minor ECG abnormalities. This study also brought to light many other factors connected to substantial ECG abnormalities, such as increased A1c, male sex, increased age, and high blood pressure.  


Within the subset of patients with significant abnormalities, there was a 9 percent prevalence of significant abnormalities in patients not diagnosed with cardiovascular disease. In addition, 15 percent of this subgroup experienced minor irregularities in their ECG. However, 23 percent of this subgroup did not have hypertension. Within the 23 percent without hypertension, only 9 percent saw minor abnormalities in their ECG, whereas 4 percent had significant abnormalities. When considering all variables, the study shows that hypertensive patients and patients who are men are at higher risk of abnormal ECG readings. 

Due to their increased risk of comorbidities such as high blood pressure and other cardiovascular disease risk factors, patients with diabetes are more likely to have irregular ECG readings. When patients have so many risk factors and comorbidities, it is advised that physicians consider monitoring the patients and ordering a baseline ECG. A physician’s decision in each instance with each patient should not be the same, however, as not all individuals with diabetes are the same. Because everyone’s situation is different, recommendations and actions taken with each patient will not always be the same. For example, patients in Europe are recommended to get an ECG if they have cardiovascular disease, high blood pressure, and diabetes. There are no set rules or guidelines in America regarding when a diabetes patient requires an ECG; it is left for the doctor to decide.  

With diabetes patients presenting a higher risk for abnormal ECG readings, they need to do everything in their power to prevent heart disease. Some preventative measures to implement are keeping blood pressure in check, limiting salt intake, keeping a healthy diet, exercising regularly, maintaining a healthy weight, stress management, limiting alcohol, and not smoking. In addition, patients can help reduce their risks by managing their medical conditions and keeping up with their medication regimens. 

Practice Pearls: 

  • Having type 2 diabetes puts a patient at a higher risk of abnormal results when an ECG is administered. 
  • Just because patients with diabetes have a greater chance of cardiovascular disease and abnormalities in their ECG results does not mean an ECG must be administered to all of them. 
  • Diabetes patients with other comorbidities such as hypertension and hyperlipidemia are at an even greater risk of having abnormal ECG readings. 


Mitchel Zoler, Ph.D. Some patients with Type 2 Diabetes Have Major ECG Abnormalities. Journal of Diabetes. Cardiology News, March 2, 2021. 

Peter P. Harms, Amber A. van der Heijden, Prevalence of ECG abnormalities in people with type 2 diabetes: The Hoorn Diabetes Care System cohort. Science Direct, February 2021.  


Oluwatayo Ishola, PharmD. Candidate, South College, School of Pharmacy