Type 2 Diabetes Increases the Need for Pacemaker Treatment - A Comparison with Age- and Sex-Matched Controls from the General Population

Background: Patients with Type 2 Diabetes mellitus (T2DM) have an increased risk for cardiovascular disease including arrhythmias. The prevalence of bradyarrhythmia and the subsequent need for treatment with pacemakers (PM) is less well explored in a contemporary patient population. The present study explores 1) whether patients with T2DM have an increased risk for PM implantation compared with an age- and sex-matched control population without DM; 2) Patient characteristics associated with risk of receiving a PM. Methods: A total of 416 014 patients with T2DM from the Swedish National Diabetes Registry (NDR) and 2 080 070 controls from the general population were included. Each patient with T2DM was compared with five age-and sex matched controls. The follow up time was 7 years. Cox's proportional hazard regression analyses were performed to estimate the risk of PM-treatment and to examine risk factors. Findings: The incidence for PM-treatment was higher in patients with T2DM than among controls (1.44% vs 0.94%; p<0.0001). T2DM was associated with an increased risk for the need of PM-treatment (Hazard ratio (HR) 1.65, 95% CI 1.60-1.69; p<0.0001) which remained (HR 1.56, 95% CI 1.51-1.60; p<0.0001) after adjustments for age, sex, educational level, marital status, country of birth and coronary heart disease. Risk factors for receiving a PM included increasing age, HbA1c, BMI, diabetes duration, blood pressure- and lipid lowering medication. Interpretation: Patients with T2DM are at an increased risk for the need of PM treatment compared to matched controls. This should be acknowledged when assessing their cardiovascular risk. Funding Statement: The authors state: not applicable. Declaration of Interests: The authors declare: none declared. Ethics Approval Statement: The study, which was conducted in agreement with the Declaration of Helsinki, was approved by the Central Ethical Review Board in Gothenburg, Sweden (DNR: 776-14, 2014-11-24).