Rationale and design of the Atherosclerosis Risk in Communities Generation 2 study

Type 2 diabetes is a risk factor for cardiac arrhythmias, but it is unknown how specific aberrations in glucose (e.g., episodes of high or low glucose) might contribute to the occurrence of heart rhythm abnormalities. The overarching goal of this study is to address research questions regarding how glucose patterns might contribute to the occurrence of arrhythmias, primarily atrial fibrillation, in adults with diabetes. To fulfill this goal, the Atherosclerosis Risk in Communities (ARIC) Gen2 study recruited 507 community-dwelling adults aged 50-80 years with type 2 diabetes to wear continuous glucose monitoring (CGM) and electrocardiogram (ECG) "patch" monitoring sensors simultaneously for up to 14 days. Gen2 study had high CGM and ECG completeness: the median wear time for sensors was 14 days and approximately 80% of participants wore both sensors for ≥10 days. By combining Gen2 and data from the original ongoing ARIC cohort (aged 80+), we have the capacity to conduct a comprehensive evaluation of the impact of CGM-defined glucose patterns on arrhythmias across a wide age spectrum from middle-aged to very old adults (aged 50-100) with type 2 diabetes. The findings from this study may help inform clinical strategies for the prevention and management of arrhythmias among adults with type 2 diabetes.