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Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus

BACKGROUND: Deteriorated arterial function and high incidence of cardiovascular events characterise diabetes mellitus. Metformin and recent antidiabetic drugs, SGLT2 inhibitors, reduce cardiovascular events. We explored the possible effects of empagliflozin’s effect on top of metformin treatment on...

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Autores principales: Lunder, Mojca, Janić, Miodrag, Japelj, Miha, Juretič, Andrej, Janež, Andrej, Šabovič, Mišo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276165/
https://www.ncbi.nlm.nih.gov/pubmed/30509271
http://dx.doi.org/10.1186/s12933-018-0797-6
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author Lunder, Mojca
Janić, Miodrag
Japelj, Miha
Juretič, Andrej
Janež, Andrej
Šabovič, Mišo
author_facet Lunder, Mojca
Janić, Miodrag
Japelj, Miha
Juretič, Andrej
Janež, Andrej
Šabovič, Mišo
author_sort Lunder, Mojca
collection PubMed
description BACKGROUND: Deteriorated arterial function and high incidence of cardiovascular events characterise diabetes mellitus. Metformin and recent antidiabetic drugs, SGLT2 inhibitors, reduce cardiovascular events. We explored the possible effects of empagliflozin’s effect on top of metformin treatment on endothelial function and arterial stiffness parameters in type 1 diabetes mellitus (T1DM) patients. METHODS: Forty T1DM patients were randomised into three treatment groups: (1) empagliflozin (25 mg daily), (2) metformin (2000 mg daily) and (3) empagliflozin/metformin (25 mg daily and 2000 mg daily, respectively). The fourth group received placebo. Arterial function was assessed at inclusion and after 12 weeks treatment by: endothelial function [brachial artery flow-mediated dilation (FMD), reactive hyperaemia index (RHI)], arterial stiffness [pulse wave velocity (PWV) and common carotid artery stiffness (β-stiffness)]. For statistical analysis one-way analysis of variance with Bonferroni post-test was used. RESULTS: Empagliflozin on top of metformin treatment significantly improved endothelial function as did metformin after 12 weeks of treatment: FMD [2.6-fold (P < 0.001) vs. 1.8-fold (P < 0.05)] and RHI [1.4-fold (P < 0.01) vs. 1.3-fold (P < 0.05)]. Empagliflozin on top of metformin treatment was superior to metformin in improving arterial stiffness parameters; it significantly improved PWV and β-stiffness compared to metformin [by 15.8% (P < 0.01) and by 36.6% (P < 0.05), respectively]. Metformin alone did not influence arterial stiffness. CONCLUSION: Empagliflozin on top of metformin treatment significantly improved arterial stiffness compared to metformin in T1DM patients. Endothelial function was similarly improved in all treatment groups. Empagliflozin seems to possess a specific capacity to decrease arterial stiffness, which could support its cardioprotective effects observed in large clinical studies. Trial registration Clinical trial registration: NCT03639545
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spelling pubmed-62761652018-12-06 Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus Lunder, Mojca Janić, Miodrag Japelj, Miha Juretič, Andrej Janež, Andrej Šabovič, Mišo Cardiovasc Diabetol Original Investigation BACKGROUND: Deteriorated arterial function and high incidence of cardiovascular events characterise diabetes mellitus. Metformin and recent antidiabetic drugs, SGLT2 inhibitors, reduce cardiovascular events. We explored the possible effects of empagliflozin’s effect on top of metformin treatment on endothelial function and arterial stiffness parameters in type 1 diabetes mellitus (T1DM) patients. METHODS: Forty T1DM patients were randomised into three treatment groups: (1) empagliflozin (25 mg daily), (2) metformin (2000 mg daily) and (3) empagliflozin/metformin (25 mg daily and 2000 mg daily, respectively). The fourth group received placebo. Arterial function was assessed at inclusion and after 12 weeks treatment by: endothelial function [brachial artery flow-mediated dilation (FMD), reactive hyperaemia index (RHI)], arterial stiffness [pulse wave velocity (PWV) and common carotid artery stiffness (β-stiffness)]. For statistical analysis one-way analysis of variance with Bonferroni post-test was used. RESULTS: Empagliflozin on top of metformin treatment significantly improved endothelial function as did metformin after 12 weeks of treatment: FMD [2.6-fold (P < 0.001) vs. 1.8-fold (P < 0.05)] and RHI [1.4-fold (P < 0.01) vs. 1.3-fold (P < 0.05)]. Empagliflozin on top of metformin treatment was superior to metformin in improving arterial stiffness parameters; it significantly improved PWV and β-stiffness compared to metformin [by 15.8% (P < 0.01) and by 36.6% (P < 0.05), respectively]. Metformin alone did not influence arterial stiffness. CONCLUSION: Empagliflozin on top of metformin treatment significantly improved arterial stiffness compared to metformin in T1DM patients. Endothelial function was similarly improved in all treatment groups. Empagliflozin seems to possess a specific capacity to decrease arterial stiffness, which could support its cardioprotective effects observed in large clinical studies. Trial registration Clinical trial registration: NCT03639545 BioMed Central 2018-12-03 /pmc/articles/PMC6276165/ /pubmed/30509271 http://dx.doi.org/10.1186/s12933-018-0797-6 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Investigation
Lunder, Mojca
Janić, Miodrag
Japelj, Miha
Juretič, Andrej
Janež, Andrej
Šabovič, Mišo
Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
title Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
title_full Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
title_fullStr Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
title_full_unstemmed Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
title_short Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
title_sort empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276165/
https://www.ncbi.nlm.nih.gov/pubmed/30509271
http://dx.doi.org/10.1186/s12933-018-0797-6
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