Sodium-Glucose Cotransporter 2 Inhibitors Significantly Lower the Cardiac Electrophysiological Balance Index in Type 2 Diabetes Patients

OBJECTIVE
Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a novel group of oral antidiabetic drugs, have demonstrated cardioprotective benefits and positive metabolic effects in patients with diabetes mellitus (DM). The cardiac electrophysiological balance index (ICEB) is an eletrocardiographic ratio that provides information about the equilibrium between left ventricular depolarization and repolarization duration, offering valuable insights into the predisposition to ventricular arrhythmias. The aim of this study is to analyze the potential impact of SGLT2 inhibitors on ICEB.

METHOD
Patients were prospectively selected from a pool of 2,789 consecutive type 2 DM patients. After exclusions, 174 patients formed the monotherapy group, and 143 age- and sex-matched patients who were switched to SGLT2 inhibitor combination therapy constituted the combination therapy group. All treatment changes were supervised by endocrinologists blinded to the patient groups. Baseline and six-month electrocardiogram (ECG) data of both groups were analyzed. ICEB was defined as QT/QRS, and ICEBc as QTc/QRS.

RESULTS
Although there was no statistically significant difference between the monotherapy and combination therapy groups in terms of baseline ECG parameters, QT (385.05 ± 13.21 vs. 372.32 ± 4.32; P < 0.001), QTc (409.24 ± 8.17 vs. 383.72 ± 7.24; P < 0.001), ICEB (4.15 ± 0.51 vs. 4.03 ± 0.54; P = 0.004), and ICEBc (4.40 ± 0.75 vs. 4.16 ± 0.61; P < 0.0001) values at the six-month mark were significantly lower in the SGLT2 inhibitor group.

CONCLUSION
SGLT2 inhibitors significantly lower ICEB and ICEBc, potentially reducing ventricular susceptibility to arrhythmias as early as six months into treatment for diabetic patients.