Association between nephropathy and QT dispersion in type 2 diabetic patients



QT dispersion, Proteinuria, Urine protein creatinine ratio


Aim: Due to increased diabetes and diabetes-related mortality all over the world, the importance of appropriate and readily available screening tests for diabetic patients is increasing. In this study, we investigated the relationship between urine protein/creatinine ratio and QT dispersion. We aimed to determine the association between nephropathy and autonomic neuropathy, the two significant complications of diabetes, through simple and achievable tests.

Methods: We retrospectively evaluated the medical records of 45 male and 50 female patients, who were attended at diabetes outpatient clinic with a diagnosis of type 2 diabetes in one month period. A 12-lead electrocardiogram (ECG), HbA1 and glucose levels were evaluated. Urinary protein/creatinine ratios (P/K) were measured at spot intervals. ECGs were transferred to the computer environment, and QT intervals were calculated and corrected for the patient's heart rate using Bazett's formula. QT-max (longest QT interval), QT-min (shortest QT interval) and QT-dispersion analyzes were performed in two groups, in all patients by excluding those with ischemic heart disease. The threshold value for proteinuria detection was 91 mg/g. Spot urine protein/creatinine ratio of less than 91mg/g was accepted as normal, and those with over 91mg/g were classified as proteinuric. 

Results: The mean QT-min (388.50 ± 27.28 ms), QT-max (441.25 ± 29.76 ms) and QT dispersion (52,74 ± 16,80 ms) were significantly higher than the reference values in both groups-in all patients by excluding those with ischemic heart disease. When all cases and those with ischemic heart disease were excluded, QT dispersion value was higher in patients with proteinuria (those with urine P/K levels 91 mg/g and above). This difference was not statistically significant. (p> 0.05) In this study, we found that QT durations were long independent of cardiovascular disease in diabetic patients, but not associated with protein/creatinine ratio

Conclusion: As a result, in this study, we examined the relationship between spot urine protein/creatinine ratio and QT intervals in diabetic patients, and we did not find a significant association between the two parameters. Although there have been studies in the literature showing that there is a relationship between albumin/creatinine ratio and QT intervals, we could not find an association with P/K ratio.


Download data is not yet available.


Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291-7.

Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med. 2001;68:928–44.

Freeman R. The peripheral nervous system and diabetes. In: Weir G, Kahn R, King GL, editors. Joslin’s Diabetes Mellitus. Philadelphia: Lippincott; 2002.

Tentolourıs N, Katsilambros N, Papazachos G et al. Corrected QT interval in relation to severity of diyabetic autonomic neuropathy. Eur J Clin Invest. 1997;27:1049-54.

Robinson RT, Harris ND, Ireland RH, Macdonal IA, Heller SR. Changes in cardiac repolarization during clinical episodes of nocturnal hypoglycaemia in adults with type 1 diabetes. Diabetologia. 2004;7:312-5.

Marfella R, Nappo F, De Angelis L, Siniscalhi M, Rossi F, Giugliano D. The effect acute hyperglycemia on Qtc duration in healthy man. Diabetologia. 2000;43:571-5.

Barnas U, Schmidt A, Haas M, Kaider A, Tillawi S, Wamser P, et al. Parameters associated with chronic renal transplant failure. Nephrol Dial Transplant. 1997;12:82-5.

Ruggenenti P, Perna A, Mosconi L, Pisoni R, Remuzzi G. Urinary protein excretion rate is the best independent predictor of ESRF in nondiabetic proteinuric chronic nephropathies. Kidney Int. 1998;53:1209-16.

Redon J. Renal protection by antihypertensive drugs: insights form microalbuminuria studies. J Hypertens. 1998;16:2091.

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis. 2002;39(1):1-266.

Koopman MG, Krediet RT, Koomen GCM, Strackee J, Arisz L. Circadian rythm of proteinuria: consequences of the use of protein: creatinine ratios. Nephrol Dial Transplant. 1989;4:9-14.

Xin G, Wang M, Jiao LL, Xu GB, Wang HY. Protein to- creatinine ratio in spot urine samples as a predictor of quantitation of proteinuria. Clin Chim Acta. 2004;350:35-9.

Gai M, Motta D, Giunti S, Masini S, Mezza E, Segoloni GP, Lanfranco G. Comparison between 24-h proteinuria, urinary protein/creatinine ratio and dipstick test in patients with nephropathy: patterns of proteinuria in dipstick-negative patients. Scan J Clin Lab Invest. 2006;66:299-308.

Lane C, Brown M, Dunsmuir W, Kelly J, Mangos G. Can spot urine protein/creatinine ratio replace 24 h urine protein in usual clinical nephrology? Nephrology (Charlton). 2006;11:245-9.

Yamamoto K, Komatsu Y, Yamamoto H, Izumo H, Sanoyama K, et al. Establishment of a method to detect microalbuminuria by measuring the total urinary protein-to-creatinine ratio in diabetic patients. Tohoku J exp med. 2011;225:195-202.

Schwartz PJ, Moss AJ, Vincent GM, Crampton RS. Diagnostic criteria for the long QT syndrome. An update. Circulation. 1993;88:782-4.

Vincent GM, Timothy KW, Leppert M, et al. The spectrum of symptoms and QT intervals in carriers of the gene for the long QT syndrome. N Engl J Med. 1992;327:846-52.

Psallas M, Tentolouris N, Papadogiannid D, Doulgerakis D, Kokkinos A, Cokkinos VD, et al. QT dispersion comparison between participants with type 1 and 2 diabetes and association with microalbuminuria: J Diabetes Complications. 2006;20:88-97.

Orosz A, Baczko I, Nyiraty S, Körei AE, Putz Z, Takacs R, et al. Increased short-term beat-to-beat QT ınterval variability in patients with ımpaired glucose tolerance. Frontiers in Endocrinology. 2017;6(8):129.

Cardoso C, Salles G, Bloch K, Deccache W, Siqeira-Filho AG. Clinical determinants of increased QT dispersion in patients with diabetes mellitus. Int J Cardiol. 2001;79(2-3):253-62.

Veglio M, Giunti S, Stevens LK, Fuller JH, Perin PC. Prevalence of QT interval dispersion in type 1 diabetes and its relation with cardiac ischemia: the EURODIAB IDDM complications study group. Diabetes Care. 2002;25(4):702-7.

Chitalia VC, Kothari J, Wells EJ, Livesey JH, Robson RA, Searle M, et al. Cost benefit analysis and prediction of 24-hour proteinuria from the spot urine protein-creatinine ratio. Clin Nephrol. 2001;55:436-47.

Rutter M, Viswanath S, McComb J M, Kesteven P, MarshallS M. QT prolongation in patients with type 2 diabetes and microalbuminuria. Clin Auton Res. 2002;12:366-72.

Chapman N, Mayet J, Ozkor M, Foale R, Thom S, Poulter N. Ethnic and gender differences in electrocardiographic QT length and QT dispersion in hypertensive subjects. J Hum Hypertens. 2000;14:403-5.

Wolbrette D, Naccarelli G, Curtis A, Lehmann M, Kadish A. Gender differences in arthythmias. Clin Cardiol. 2002;25:49-56.

Ersoy U. Tip 2 diyabetli hastalarda kan şekeri düzeyi ile QT parametreleri arasındaki ilişkinin değerlendirilmesi [dissertation]. Haydarpaşa numune eğitim araştırma hastanesi; İstanbul 2008.

Sertbas Y, Ozdemir A, Sertbas M, Dayan A, Sancak S, Uyan C. The effect of glucose variability on Qtc duration and dispersion in patients with type 2 diabetes mellitus. Pak J Med Sci. 2017;33(1):22-6.






Research Article

How to Cite

Oluk B. Association between nephropathy and QT dispersion in type 2 diabetic patients. J Surg Med [Internet]. 2019 Mar. 15 [cited 2023 Apr. 1];3(3):206-9. Available from: