Background and Aim: Coexistence of hypertension (HTN) and type 2 diabetes (T2DM) multiplies the risk of cardiovascular events. Early identification and prompt management of elevated blood pressure in T2DM has shown to improve the quality of life and to reduce the economic burden to the patients. We studied blood pressure (BP) lowering effect of Azilsartan (AZST) monotherapy in newly diagnosed stage 2 hypertensives with a history of T2DM. We also analysed its effects on blood glucose and renal indices. Methods: T2DM Subjects attending a specialized diabetes clinic, who were diagnosed with HTN for the first time, were invited to participate. Mean of 3 BP readings was considered for analysis after due consent. Subjects with stage 2 hypertension were administered AZST 40mg once daily. After 3 months they had a repeat BP recording. Subjects underwent serum creatinine, Na+, K+, fasting (FPG) and postprandrial (PPG) plasma glucose measurements at baseline and after 3moths’ of enrolment. We compared BP lowering efficacy and changes in plasma glucose and renal parameters at baseline and after 3months of AZST therapy. Diabetic, dyslipidemic and other chronic medicines were continued unchanged during the study period. Results: Inclusion criteria were met by 474 subjects (117, 25% females). Mean age and duration of diabetes were 53.3 (95% CI 52.3-54.3) and 7.03 (CI 6.6-7.5) years respectively. With AZST therapy mean SBP dropped from 152.7 (CI 151.1-154.3) mm Hg to 136.4 (CI 134.9-138.0) mm Hg (p <0.05) and the post treatment DBP declined to 79.6 (CI 78.8-80.4) mm Hg from its baseline value of 90.5 (CI 89.6-91.4) mm Hg (p <0.05). The mean baseline FPG and PPG were 158.8 (CI 154.0-163.4) mg/dL and 237.3 (CI 231.9-242.7) mg/dL in order. There was a non-significant decline in plasma glucose, but no changes were seen in eGFR or electrolytes. No adverse event was reported. Conclusion: Azilsartan monotherapy was found to be safe and effective in managing newly diagnosed stage 2 hypertension in type 2 diabetes without hampering renal function. Disclosure H. Mahapatra: None. M. Khuntia: None. S. Mishra: None. S.K. Mishra: None. R.K. Padhi: None. B. Jena: None. S. Das: None. R.K. Khatua: None. A.R. Jena: None. R. Mahapatra: None. L. Mahapatra: None. A.K. Sahoo: None. Funding Jyoti Diabetes Research Foundation

Objective: People with diabetes gradually require increasing dose of medications to achieve good control. We studied the glycemic response of adding Teneligliptin (Teneli) in T2DM subjects with high HbA1c despite being on stable doses of Met and Glim dose. Methods: In this retrospective study T2DM subjects, who were on fixed doses of Met 1000 to 2000mg and Glim 1 to 6mg daily for 3 months were considered. Subjects with an HbA1c between 8-11% and who were prescribed Teneli 20mg OD for at least 6 months, were shortlisted. Those taking insulin or antidiabetic drugs other than Glim+Met or those whose dose was up-titrated during the study period were excluded. We compared HbA1c, fasting (FPG), postprandrial (PPG) plasma glucose, total cholesterol (TC), triglyceride (TG), HDL, LDL, systolic (SBP) and diastolic (DBP) blood pressure at baseline and after 6months of Teneli initiation. Results: Data of 562 subjects (229, 41% females), who met the inclusion criteria were extracted for analysis from the hospital records. Mean age of the sample was 52.6 (95% CI: 51.7-53.4) years and duration of diabetes was 7.8 (6.6-8.3) years. Addition of Teneli resulted in a drop in HbA1c from 9.6% (8.2-10.6) to 8.8% (7.1-9.4) (p<0.05). FPG decreased from 158.8 (154.3-163.2) to 127.8 (124.5-131.1) and PPG from 236.4 (230.7-242.0) to 191.0 (186.0-196.0) respectively (p <0.05). Teneli also improved lipid parameters significantly, particularly TC and TG. With Tenali, SBP declined from 136.8 (134.8-137.9) to 129.5 (128.1-130.9) and DBP from 83.1 (82.2-83.9) to 81.0 (80.2-81.9). There was no incidence of severe hypoglycemia, though 18 (3.2%) cases of suspected hypoglycemia were managed at home. Conclusion: Adding Teneli to Met and Glim combination showed promising role in improving glycemic parameters, lipid components and blood pressure. Low hypoglycemia risk makes the drug a suitable add-on option for those with high HbA1c values. Disclosure H. Mahapatra: None. S. Mishra: None. M. Khuntia: None. B. Jena: None. S. Das: None. A.R. Jena: None. R.K. Padhi: None. A.K. Sahoo: None. R. Mahapatra: None. L. Mahapatra: None.

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SGLT2 inhibitors have gained appreciation following their acceptance as a treatment modality for people with type 2 diabetes. These agents promote glucosuia blocking the reabsorption of glucose from the proximal convoluted tubules in the kidneys. Due to the direct role on the nephrons, initially there were some concerns over their use among the renal compromised individuals. Urinary albumin to creatinine ratio (UACR) is considered as one of the indicators to access the renal function and to classify chronic kidney disease. RAAS blockers are the standard therapeutic options for reducing urinary albumin excretion among those with or without diabetes. This study aimed to find the renoprotective effect of dapagliflozin (DAPA) among obese Indian type 2 diabetics (T2D) with microalbuminuria and compared that with RAAS blockers. We considered 182 obese adults (BMI ≥30 kg/m2) with T2D and microalbuminuria for this study. Subjects were randomized into 2 groups. Those in DAPA group (n = 86, M/F: 51/35) were administered DAPA 10 mg once daily with breakfast, whereas subjects in the comparator (RAAS) arm (n = 96, M/F 54/42) were prescribed RAAS blockers (ARBs or ACE inhibitors). From comparable UACR and HbA1c at baseline, both groups witnessed a significant decline in the UACR at 12 weeks of intervention (p<0.02). The change in the UACR from baseline was higher in the DAPA arm, though it was not statistically different from RAAS arm (145.7± 32.8 to 89.5 ± 35.8 mg/g vs. 131.5 ± 44.6 to 94.3 ± 28.2 mg/g). Additionally, DAPA arm in contrast to RAAS arm, proved their glycemic benefits by demonstrating a significant reduction in the HbA1c (1.5 ± 1.2% vs. 0.3 ± 0.6%). There was a drop in blood pressure in the study and comparator arms, but RAAS agents were found to be more effective in lowering blood pressure (P <0.03). Dapagliflozin exhibited significant and numerically better reduction in UACR compared to RAAS blocking agents among obese microalbuminuric diabetics. Use of dapagliflozin also resulted in significant Hba1c reduction. Disclosure H. Mahapatra: None. L. Mahapatra: None. M. Khuntia: None. A. K. Sahoo: None.

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