Applied Sciences

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Electrocardiographic Signatures of Dysglycaemia: Mechanistic Foundations, Digital Biomarkers, and Artificial Intelligence for Non-Invasive Diabetes Risk Stratification
(Multidisciplinary Digital Publishing Institute, 2026-03-18)
Chingiz A. Alimbayev
;
Zhadyra N. Alimbayeva
;
Kassymbek Ozhikenov
;
Kairat Karibayev
;
Zhansila Orynbay
Diabetes mellitus is projected to affect more than 1.3 billion people worldwide by 2050, with millions remaining undiagnosed or in a prediabetic state. Cardiovascular complications account for nearly half of diabetes-related deaths, highlighting the need for scalable tools capable of identifying metabolic dysregulation before irreversible cardiac damage develops. This review synthesizes current mechanistic, clinical, and computational evidence linking diabetes to cardiac electrophysiological remodeling and examines electrocardiography (ECG) as a non-invasive modality for early detection of dysglycaemia. Chronic hyperglycaemia, insulin resistance, oxidative stress, microvascular dysfunction, and cardiac autonomic neuropathy collectively contribute to measurable ECG alterations, including QT/QTc prolongation, increased QT dispersion, changes in Tp–e indices, and reduced heart rate variability. These changes often precede overt cardiovascular disease and correlate with glycaemic burden and diabetes duration. Recent advances in signal processing and artificial intelligence have expanded the diagnostic potential of ECG. Both classical machine learning approaches and large-scale deep learning models demonstrate that ECG contains latent signatures associated with incident type 2 diabetes and glycaemic status. Despite promising results, heterogeneity in study design, limited representation of prediabetes, and lack of standardized validation frameworks remain major barriers to clinical translation. Prospective, multi-ethnic studies are needed to establish ECG-based screening as a reliable component of early diabetes detection strategies.
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A Structured Critical Review of Machine Learning Approaches for ECG-Based Detection of Dysglycemia and Their Translational Readiness
(Multidisciplinary Digital Publishing Institute, 2026-05-27)
Zhadyra N. Alimbayeva
;
Chingiz A. Alimbayev
;
Kassymbek Ozhikenov
;
Aiman K. Ozhikenova
;
Ussen Shylmyrza
This structured critical review provides a comparative and analytically grounded overview of machine learning (ML) approaches for electrocardiography (ECG)-based detection of dysglycemia, with a specific focus on translational readiness for clinical screening. A structured literature search across PubMed, Scopus, Web of Science, and IEEE Xplore identified 183 records, of which 17 studies were included following predefined screening criteria and PRISMA-guided selection principles. The included studies demonstrate substantial heterogeneity in dataset size (ranging from 25,000 subjects), ECG acquisition modalities (single-lead, 12-lead, wearable), feature representations (raw signals, heart rate variability, engineered features), and ML strategies (classical algorithms, deep learning, and multimodal models). Reported model performance is generally high, with accuracy values frequently exceeding 0.85 and area under the curve (AUC) ranging from 0.78 to 0.99. Smaller experimental studies often report inflated performance (up to 96–99% accuracy), whereas large-scale population-based investigations demonstrate more moderate but clinically plausible results (AUC ≈ 0.80–0.85). External validation, a key requirement for clinical applicability, was performed in only a limited subset of studies (approximately 12%). From a physiological perspective, ML models exploit ECG alterations associated with dysglycemia, including reduced heart rate variability, QT interval prolongation, and changes in ventricular depolarization and repolarization dynamics. However, the relationship between metabolic dysfunction and ECG signals remains indirect. A key finding of this review is the mismatch between reported predictive performance and translational readiness. The majority of studies (≈65–70%) are classified as early-stage (Level 1–2 or 2–3), relying on small, single-center datasets and internal validation. Only a minority of studies achieve near-translational maturity (Level 4), characterized by large-scale datasets and external validation. ECG-based dysglycemia detection represents a promising non-invasive and scalable screening paradigm. However, its clinical translation is constrained by the lack of standardized ECG acquisition protocols, limited dataset diversity, insufficient external validation, and fragmented methodological approaches. Future research should prioritize large multi-center datasets, standardized feature extraction pipelines, hybrid interpretable models, and prospective validation to enable robust, generalizable, and clinically deployable screening systems.

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