The effect of various classes of glucose-lowering medications on the blood vessel elasticity in patients with type 2 diabetes

Abstract

Aim. To study the effect of various classes of glucose-lowering agents (dipeptidyl peptidase-4 (DPP-4) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors) on the vascular stiffness in patients with type 2 diabetes (T2D) and high cardiovascular risk.Material and methods. The open-label, prospective 24-week study included 120 patients with T2D and high cardiovascular risk. We evaluated the effect of modern glucose-lowering medications, empagliflozin at a dose of 25 mg/day (SGLT-2 inhibitor) and sitagliptin at a dose of 100 mg/day (DPP-4 inhibitor), on vascular elasticity, central hemodynamic and laboratory parameters.Results. After 24-week therapy, the target glycated hemoglobin level reached 71% and 80% of patients in the sitagliptin and empagliflozin groups, respectively. In both groups, vascular stiffness and central hemodynamic parameters were improved. However, significant changes were recorded only in the empagliflozin (carotid-femoral pulse wave velocity decreased by 14,4%, augmentation index — by 6%, central pulse pressure — by 7,8%) (p<0,05). Use of sitagliptin was associated with significant improvements in the lipid profile (total cholesterol decreased by 9,5%, triglycerides — by 21%, low density lipoproteins — by 15,1%; high density lipoproteins increased by 15,7%) (p<0,05). In the empagliflozin group, anthropometric parameters were improved (body mass index decreased by 9,1%, waist circumference — by 4,1%) (p<0,05). Patients in both groups had a significant decrease in HOMA-IR index and highly sensitive C-reactive protein: by 34% and 51,6% in the empagliflozin group and by 31,8% and 22,1% in the sitagliptin group, respectively (p<0,05).Conclusion. The use of empagliflozin is more associated with arterial stiffness decrease in T2D patients with high cardiovascular risk compared with sitagliptin.

Meta-analysis of the effect of sodium-dependent glucose transporter 2 inhibitors on C-reactive protein in type 2 diabetes

“…Figure 1 outlines the search and selection process. Of the 13 included studies [8][9][10][11][12][13][14][15][16][17][18][19][20] (Table 1), 8 were case-control experimental studies and 5 were prospective experimental studies evaluating the changes in CRP before and after treatment with SGLT-2 inhibitors among patients with T2DM (Table 2); these studies were published from 2016 to 2021 and included data for a total of 927 patients. The quality of studies was evaluated with Newcastle-Ottawa Quality Assessment Scale, as shown in Table 3.…”