2094-LB: Electrocardiogram Abnormalities in Relatively Early Type 2 Diabetes—Prevalence and Incidence in the Glycemia Reduction Approaches in Diabetes (GRADE) Cohort

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Introduction and Objective: To describe the prevalence and incidence of electrocardiogram (ECG) abnormalities and ECG evidence of cardiovascular (CV) autonomic neuropathy (CAN) by treatment group in the GRADE cohort of adults with type 2 diabetes (T2D) for <10 years. Methods: The GRADE trial enrolled individuals with T2D <10 years on metformin alone, randomized to insulin glargine, glimepiride, liraglutide, or sitagliptin, and followed for an average of five years. Resting ECGs were completed at baseline, 2-, and 4-years in 5029 participants (baseline mean ± SD age 57.2 ± 10.0 years; diabetes duration 4.2 ± 2.7 years; HbA1c 7.5 ± 0.5%; 36.4% women) and analyzed for overall, major, and minor abnormalities and heart rate variability (HRV), a measure of CAN. Incidence of new ECG abnormalities and CAN by treatment group were analyzed at years 2 and 4 using logistic repeated measures models, adjusted for baseline risk factors. As liraglutide is associated with CV outcomes benefit, ECG changes in the liraglutide vs. all other groups were also compared. Results: Participants with ECG abnormalities (57.1%) and ECG-defined CAN (52.8%) at baseline had longer diabetes duration, higher systolic blood pressure, more hyperlipidemia and lipid-lowering treatment, and beta blocker use. Across years 2 and 4, there were no between-group differences in overall or minor ECG abnormalities, but major ECG abnormalities occurred less often in the liraglutide vs. all other treatment groups (p=0.03; 9% [95% CI: 7%, 12%] vs 13% [11%, 14%] at year 4). ECG-defined CAN did not differ between liraglutide vs. non-liraglutide groups across years 2 and 4 (p=0.42). Conclusion: ECG abnormalities, including those of CAN, are common in T2D <10 years and are associated with certain CV risk factors. The development of major ECG abnormalities may differ by glucose lowering treatment, as fewer occurred with liraglutide vs. the other treatments. Disclosure R. Pop-Busui: Board Member; American Diabetes Association. Consultant; Averitas Pharma, Inc. Research Support; Bayer Pharmaceuticals, Inc. Other Relationship; Biogen. Research Support; Juvenile Diabetes Research Foundation (JDRF). Advisory Panel; Lexicon Pharmaceuticals, Inc, Novo Nordisk. Research Support; Novo Nordisk, National Institute of Diabetes and Digestive and Kidney Diseases. Consultant; Roche Diagnostics. S. Rosin: None. N.M. Butera: None. H. Krause-Steinrauf: None. H. Abou Assi: Research Support; Novo Nordisk. Stock/Shareholder; Gilead Sciences, Inc, Regeneron Pharmaceuticals, Medtronic, Moderna, Inc, MannKind Corporation, Merck & Co., Inc, Pfizer Inc. R.K. Garg: None. S.E. Inzucchi: Consultant; Novo Nordisk, AstraZeneca, Boehringer-Ingelheim, Merck & Co., Inc, Pfizer Inc, Bayer Pharmaceuticals, Inc. A. Katona: None. J.B. McGill: Advisory Panel; Bayer Pharmaceuticals, Inc. Consultant; Jaeb Center for Health Research. Advisory Panel; Boehringer-Ingelheim, Lilly Diabetes, Novo Nordisk, MannKind Corporation. Research Support; Diagnode, Lexicon Pharmaceuticals, Inc, Biomea Fusion. S. Mudaliar: Consultant; Sun Pharmaceutical Industries Ltd. D.S. Schade: None. E.R. Seaquist: None. M. Tiktin: None. E.Z. Soliman: None. J.B. Green: Consultant; BI Lilly NovoNordisk Bayer Anji Vertex Valo Mineralys AstraZeneca. Research Support; BI Lilly Merck Bluedrop Roche. Funding NIDDK (U01DK098246, U34-DK-088043); American Diabetes Association; National Heart, Lung, and Blood Institute; The Centers for Disease Control and Prevention

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