Comparison of effects of sitagliptin and voglibose on left ventricular diastolic dysfunction in patients with type 2 diabetes: results of the 3D trial

Cardiovascular Diabetology

Hiroshi Ito³  Junichi Yoshikawa⁴  Kumiko Hirata²  Toru Miyoshi³  Tsutomu Takagi⁵  Shota Fukuda⁸  Kenei Shimada¹  Hajime Kihara⁶  Kazufumi Nakamura³  Hiroki Oe⁷ 

[1] Department of Internal Medicine and Cardiology, Osaka City University of Medicine, Osaka, Japan;Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan;Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan;Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Japan;Takagi Cardiology Clinic, Kyoto, Japan;Department of Internal Medicine, Kihara Cardiovascular Clinic, Asahikawa, Japan;Center of Ultrasonic Diagnostics, Okayama University Hospital, Okayama, Japan;Department of Medicine, Osaka Ekisaikai Hospital, Osaka, Japan

关键词: LV diastolic function;    Alpha-glucosidase inhibitor;    Dipeptidyl peptidase 4 (DPP-4) inhibitors;   

Others  :  1216825
DOI  :  10.1186/s12933-015-0242-z

 received in 2015-02-20, accepted in 2015-06-05,  发布年份 2015

【 摘 要 】

Background

Left ventricular (LV) diastolic dysfunction is frequently observed in patients with type 2 diabetes. Dipeptidyl peptidase-4 inhibitor (DPP-4i) attenuates postprandial hyperglycemia (PPH) and may have cardio-protective effects. It remains unclear whether DPP-4i improves LV diastolic function in patients with type 2 diabetes, and, if so, it is attributable to the attenuation of PPH or to a direct cardiac effect of DPP-4i. We compared the effects of the DPP-4i, sitagliptin, and the alpha-glucosidase inhibitor, voglibose, on LV diastolic function in patients with type 2 diabetes.

Methods

We conducted a prospective, randomized, open-label, multicenter study of 100 diabetic patients with LV diastolic dysfunction. Patients received sitagliptin (50 mg/day) or voglibose (0.6 mg/day). The primary endpoints were changes in the e’ velocity and E/e’ ratio from baseline to 24 weeks later. The secondary efficacy measures included HbA1c, GLP-1, lipid profiles, oxidative stress markers and inflammatory markers.

Results

The study was completed with 40 patients in the sitagliptin group and 40 patients in the voglibose group. There were no significant changes in the e’ velocity and E/e’ ratio from baseline to 24 weeks later in both groups. However, analysis of covariance demonstrated that pioglitazone use is an independent factor associated with changes in the e’ and E/e’ ratio. Among patients not using pioglitazone, e’ increased and the E/e’ ratio decreased in both the sitagliptin and voglibose groups. GLP-1 level increased from baseline to 24 weeks later only in the sitagliptin group (4.8 ± 4.7 vs. 7.3 ± 5.5 pmol/L, p < 0.05). The reductions in HbA1c and body weight were significantly greater in the sitagliptin group than in the voglibose group (−0.7 ± 0.6 % vs. −0.3 ± 0.4, p < 0.005; −1.3 ± 3.2 kg vs. 0.4 ± 2.8 kg, p < 0.05, respectively). There were no changes in lipid profiles and inflammatory markers in both groups.

Conclusions

Our trial showed that sitagliptin reduces HbA1c levels more greatly than voglibose does, but that neither was associated with improvement in the echocardiographic parameters of LV diastolic function in patients with diabetes.

Trial registration

Registered at http://www.umin.ac.jp under UMIN000003784

【 授权许可】

   
2015 Oe et al.

【 图 表 】

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