Left ventricular diastolic function in patients with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor- a pilot study

Diabetology & Metabolic Syndrome

Maria Elizabeth Rossi da Silva¹  José Lázaro Andrade²  Rosa Ferreira dos Santos¹  Marcia Regina Silva Correia¹  Rosa Tsuneshiro Fukui¹  Meive Furtado²  Katia Camarano Nogueira¹ 

[1] Laboratório de Carboidratos e Radioimunensaio LIM-18 do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo, 455 sala 3324, Sao Paulo, SP, Brazil;Serviço de Ecocardiografia do Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil

关键词: Glucagon-like peptide 1;    Cardiovascular function;    Bedtime NPH insulin;    Dypeptidil-peptidase-4 inhibitor;    Type 2 diabetes mellitus (T2DM);   

Others  :  1114976
DOI  :  10.1186/1758-5996-6-103

 received in 2014-06-29, accepted in 2014-09-20,  发布年份 2014

【 摘 要 】

Background

Blood glucose control is fundamental albeit not enough to prevent diabetic macrovascular complications. Dipeptidyl peptidase-4 (DPP-4) inhibitors are effective in improving metabolic parameters in patients with type 2 diabetes mellitus (T2DM) but little is known about its cardiovascular effects. We compared the DPP-4 inhibitor sitagliptin with bedtime NPH insulin (NPH) as add-on therapy in patients with T2DM, aiming to ascertain which drug would have additional cardioprotective effects.

Methods

Thirty-five T2DM patients inadequately controlled with metformin plus glyburide were randomized to receive sitagliptin (n = 18) or NPH (n = 17) for 24 weeks. Fasting plasma glucose, HbA1c, lipid profile, C-reactive protein, active glucagon-like peptide (aGLP-1) levels, 24-hour ambulatory blood pressure measurement and comprehensive 2-dimensional echocardiogram were determined before and after treatments.

Results

Both sitagliptin and NPH therapies decreased HbA1c levels after 24 weeks. Fasting plasma glucose and triglyceride levels decreased in the NPH group whereas only sitagliptin increased aGLP-1 levels. Left ventricular diastolic dysfunction (LVDD) was detected in 58.6% of twenty-nine patients evaluated. Beneficial effects in LVDD were observed in 75% and 11% of patients treated with sitagliptin and NPH, respectively (p = 0.015). Neither therapy changed C-reactive protein or blood pressure.

Conclusions

Sitagliptin and bedtime NPH were similarly effective on glucose control. Improvement in LVDD in T2DM patients treated with sitagliptin was suggested, probably related to the increase of aGLP-1 levels. Therefore, DPP-4 inhibitor seems to have cardioprotective effects independent of glucose control and may have a role in the prevention of diabetic cardiomyopathy.

【 授权许可】

   
2014 Nogueira et al.; licensee BioMed Central Ltd.

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