Effect of sodium-glucose co-transporter-2 inhibitors on impaired ventricular repolarization in people with Type 2 diabetes

AimsTo test the hypothesis that treatment with a sodium-glucose co-transporter-2 inhibitor would reverse ventricular repolarization heterogeneity, a predictor of cardiovascular mortality, in people with Type 2 diabetes. MethodsWe retrospectively analysed changes in indices of ventricular repolarization before and after treatment with a sodium-glucose co-transporter-2 inhibitor in 46 people with Type 2 diabetes. ResultsSodium-glucose co-transporter-2 inhibitor treatment reduced HbA(1c) concentration [6213 mmol/mol (7.71.2%) vs 5916 mmol/mol (7.51.4%)], body weight (77.8 +/- 13.9 vs 74.7 +/- 12.5 kg) and systolic blood pressure (133 +/- 18 vs 126 +/- 12 mmHg) in the study participants. Heart rate and QTc interval were not changed by sodium-glucose co-transporter-2 inhibitor treatment, but QTc dispersion was significantly reduced (median, 48.8 vs 44.2 ms). Sodium-glucose co-transporter-2 inhibitor treatment reversed QTc dispersion more in participants who had larger QTc dispersion before the treatment. Changes in systolic blood pressure (Spearman's = 0.319; P=0.031), but not in HbA(1c) concentration, were correlated with changes in QTc dispersion after sodium-glucose co-transporter-2 inhibitor treatment. ConclusionsThe findings suggest that sodium-glucose co-transporter-2 inhibitor treatment reverses ventricular repolarization heterogeneity in people with Type 2 diabetes, independently of its effect on glycaemic control. The favourable effect on ventricular repolarization heterogeneity could be the mechanism by which empaglifozin reduced cardiovascular events in a recent study.