Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
Abstract 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 treat...
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doaj-68eb198edf3e4ada8885873eda295ac92020-11-24T21:57:28ZengBMCCardiovascular Diabetology1475-28402018-12-011711810.1186/s12933-018-0797-6Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitusMojca Lunder0Miodrag Janić1Miha Japelj2Andrej Juretič3Andrej Janež4Mišo Šabovič5Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre LjubljanaDepartment of Vascular Diseases, University Medical Centre LjubljanaDepartment of Vascular Diseases, University Medical Centre LjubljanaDepartment of Vascular Diseases, University Medical Centre LjubljanaDepartment of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre LjubljanaDepartment of Vascular Diseases, University Medical Centre LjubljanaAbstract 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: NCT03639545http://link.springer.com/article/10.1186/s12933-018-0797-6EmpagliflozinMetforminEmpagliflozin/metforminVascular protectionArterial stiffnessEndothelial function |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mojca Lunder Miodrag Janić Miha Japelj Andrej Juretič Andrej Janež Mišo Šabovič |
spellingShingle |
Mojca Lunder Miodrag Janić Miha Japelj Andrej Juretič Andrej Janež Mišo Šabovič Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus Cardiovascular Diabetology Empagliflozin Metformin Empagliflozin/metformin Vascular protection Arterial stiffness Endothelial function |
author_facet |
Mojca Lunder Miodrag Janić Miha Japelj Andrej Juretič Andrej Janež Mišo Šabovič |
author_sort |
Mojca Lunder |
title |
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_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_sort |
empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus |
publisher |
BMC |
series |
Cardiovascular Diabetology |
issn |
1475-2840 |
publishDate |
2018-12-01 |
description |
Abstract 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 |
topic |
Empagliflozin Metformin Empagliflozin/metformin Vascular protection Arterial stiffness Endothelial function |
url |
http://link.springer.com/article/10.1186/s12933-018-0797-6 |
work_keys_str_mv |
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