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

Aims To 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. Methods We 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. Results Sodium‐glucose co‐transporter‐2 inhibitor treatment reduced HbA 1c concentration [62±13 mmol/mol (7.7±1.2%) vs 59±16 mmol/mol (7.5±1.4%)], 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 QT c interval were not changed by sodium‐glucose co‐transporter‐2 inhibitor treatment, but QT c dispersion was significantly reduced (median, 48.8 vs 44.2 ms). Sodium‐glucose co‐transporter‐2 inhibitor treatment reversed QT c dispersion more in participants who had larger QT c dispersion before the treatment. Changes in systolic blood pressure (Spearman's ρ= 0.319; P =0.031), but not in HbA 1c concentration, were correlated with changes in QT c dispersion after sodium‐glucose co‐transporter‐2 inhibitor treatment. Conclusions The 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.