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Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial

BACKGROUND: Empagliflozin reduces the risk of cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM) and high cardiovascular risk via mechanisms which have not been fully explained. The mechanisms of such benefit have not been fully understood, and whether empagliflozin can be safely a...

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Autores principales: Fortin, Elena, Lundin, Magnus, Mellbin, Linda, Norhammar, Anna, Näsman, Per, Smetana, Stina, Sörensson, Peder, Ferrannini, Ele, Rydén, Lars, Ferrannini, Giulia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10422806/
https://www.ncbi.nlm.nih.gov/pubmed/37568149
http://dx.doi.org/10.1186/s12933-023-01950-0
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author Fortin, Elena
Lundin, Magnus
Mellbin, Linda
Norhammar, Anna
Näsman, Per
Smetana, Stina
Sörensson, Peder
Ferrannini, Ele
Rydén, Lars
Ferrannini, Giulia
author_facet Fortin, Elena
Lundin, Magnus
Mellbin, Linda
Norhammar, Anna
Näsman, Per
Smetana, Stina
Sörensson, Peder
Ferrannini, Ele
Rydén, Lars
Ferrannini, Giulia
author_sort Fortin, Elena
collection PubMed
description BACKGROUND: Empagliflozin reduces the risk of cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM) and high cardiovascular risk via mechanisms which have not been fully explained. The mechanisms of such benefit have not been fully understood, and whether empagliflozin can be safely administered as first-line treatment in patients with CVD at the initial stages of glycaemic perturbations remains to be established. We investigated the effects of empagliflozin on insulin resistance, insulin sensitivity and β-cell function indexes in patients with a recent acute coronary event and newly detected dysglycaemia, i.e., impaired glucose tolerance (IGT) or T2DM. METHODS: Forty-two patients (mean age 67.5 years, 19% females) with a recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected dysglycaemia were randomized to either empagliflozin 25 mg daily (n = 20) or placebo (n = 22). Patients were investigated with stress-perfusion cardiac magnetic resonance imaging before randomization, 7 months after the start of study drug and 3 months following its cessation. Indexes of insulin resistance, sensitivity and β-cell function were calculated based on glucose and insulin values from 2-hour oral glucose tolerance tests (OGTT) and fasting C-peptide. The differences in glucose, insulin, C-peptide, mannose levels and indexes between the two groups were computed by repeated measures ANOVA including an interaction term between the treatment allocation and the time of visit. RESULTS: After 7 months, empagliflozin significantly decreased glucose and insulin values during the OGTT, whereas C-peptide, mannose and HbA1c did not differ. Empagliflozin significantly improved insulin sensitivity indexes but did not impact insulin resistance and β-cell function. After cessation of the drug, all indexes returned to initial levels. Insulin sensitivity indexes were inversely correlated with left ventricular mass at baseline. CONCLUSIONS: Empagliflozin improved insulin sensitivity indexes in patients with a recent coronary event and drug naïve dysglycaemia. These findings support the safe use of empagliflozin as first-line glucose-lowering treatment in patients at very high cardiovascular risk with newly diagnosed dysglycaemia. TRIAL REGISTRATION NUMBER: EudraCT number 2015-004571-73. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-023-01950-0.
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spelling pubmed-104228062023-08-13 Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial Fortin, Elena Lundin, Magnus Mellbin, Linda Norhammar, Anna Näsman, Per Smetana, Stina Sörensson, Peder Ferrannini, Ele Rydén, Lars Ferrannini, Giulia Cardiovasc Diabetol Research BACKGROUND: Empagliflozin reduces the risk of cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM) and high cardiovascular risk via mechanisms which have not been fully explained. The mechanisms of such benefit have not been fully understood, and whether empagliflozin can be safely administered as first-line treatment in patients with CVD at the initial stages of glycaemic perturbations remains to be established. We investigated the effects of empagliflozin on insulin resistance, insulin sensitivity and β-cell function indexes in patients with a recent acute coronary event and newly detected dysglycaemia, i.e., impaired glucose tolerance (IGT) or T2DM. METHODS: Forty-two patients (mean age 67.5 years, 19% females) with a recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected dysglycaemia were randomized to either empagliflozin 25 mg daily (n = 20) or placebo (n = 22). Patients were investigated with stress-perfusion cardiac magnetic resonance imaging before randomization, 7 months after the start of study drug and 3 months following its cessation. Indexes of insulin resistance, sensitivity and β-cell function were calculated based on glucose and insulin values from 2-hour oral glucose tolerance tests (OGTT) and fasting C-peptide. The differences in glucose, insulin, C-peptide, mannose levels and indexes between the two groups were computed by repeated measures ANOVA including an interaction term between the treatment allocation and the time of visit. RESULTS: After 7 months, empagliflozin significantly decreased glucose and insulin values during the OGTT, whereas C-peptide, mannose and HbA1c did not differ. Empagliflozin significantly improved insulin sensitivity indexes but did not impact insulin resistance and β-cell function. After cessation of the drug, all indexes returned to initial levels. Insulin sensitivity indexes were inversely correlated with left ventricular mass at baseline. CONCLUSIONS: Empagliflozin improved insulin sensitivity indexes in patients with a recent coronary event and drug naïve dysglycaemia. These findings support the safe use of empagliflozin as first-line glucose-lowering treatment in patients at very high cardiovascular risk with newly diagnosed dysglycaemia. TRIAL REGISTRATION NUMBER: EudraCT number 2015-004571-73. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-023-01950-0. BioMed Central 2023-08-11 /pmc/articles/PMC10422806/ /pubmed/37568149 http://dx.doi.org/10.1186/s12933-023-01950-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Fortin, Elena
Lundin, Magnus
Mellbin, Linda
Norhammar, Anna
Näsman, Per
Smetana, Stina
Sörensson, Peder
Ferrannini, Ele
Rydén, Lars
Ferrannini, Giulia
Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial
title Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial
title_full Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial
title_fullStr Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial
title_full_unstemmed Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial
title_short Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: Experiences from the randomized, controlled SOCOGAMI trial
title_sort empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia: experiences from the randomized, controlled socogami trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10422806/
https://www.ncbi.nlm.nih.gov/pubmed/37568149
http://dx.doi.org/10.1186/s12933-023-01950-0
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