The combination of dulaglutide and dapagliflozin improves arterial stiffness, endothelial glycocalyx and albuminuria vs DPP-4 inhibitors independently of glycemic control. (14th October 2021)

• Record Type: Journal Article
• Authors: Korakas, E; Ikonomidis, I; Thymis, J; Kountouri, A; Katogiannis, K; Benas, D; Prentza, V; Balampanis, K; Pliouta, L; Kousathana, F; Kostelli, G; Dimitriadis, G; Raptis, A; Lambadiari, V
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Pharmacotherapy; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.2648
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Studies in recent years have shown that dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), and dapagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT-2i), improve or prevent diabetic nephropathy and macrovascular complications in patients with type 2 diabetes mellitus (T2DM). Purpose: The aim of this study is to determine whether the combination of dulaglutide and dapagliflozin exerts improves arterial stiffness, endothelial glycocalyx and albuminuria in T2DM compared to dipeptidyl-peptidase 4 inhibitors (DPP-4is). Methods: Overall 37 patients with T2DM were included in our study. 21 patients were transitioned from DPP-4is to dulaglutide and dapagliflozin (treatment group) and were followed immediately prior (baseline) and 4 months after the initiation of treatment. 16 patients, matched for sex, age and glycemic control, remained on treatment with DPP-4is (control group). In each visit we measured a) Carotid-femoral PWV b) central systolic blood pressure (cSBP) c) perfused boundary region (PBR) of the sublingual arterial microvessels, d) urinary albumin-to-creatinine ratio (UACR), e) glycosylated hemoglobin (HbA1c). Results: There were no statistically significant differences in cardiovascular markers, UACR and HbA1c at baseline (p>0.05). After 4 months, patients on dulaglutide and dapagliflozin combination improved HbA1c (7.9±1.5% vs 6.59±0.6%, p<0.001), PBR (2.3±0.3 vs. 2.1±0.2 μm, p<0.05), PWV (11.9±0.3.5 vs. 10.9±2.2m/s, p<0.05), cSBP (128.5±23.6 vs. 121.1±15.7 mmHg, p<0.05) and UACR (413.66±352.57 vs. 248.06±203.5 mg/g, p<0.001). There were no statistically significant differences in PBR (2.1±0.3 vs. 2.2±0.3 μm, p>0.05), PWV (10.7±3.4 vs. 12±3.3m/s, p>0.05), cSBP (125.4±21.2 vs. 127±20.1 mmHg, p>0.05) and UACR (240.8±103.6 vs. 204.9±119.6 mg/g), in the control group, despite a statistically significant improvement of HbA1c (8.2±1.9% vs 7.3±1.3%, p<0.01). Conclusions: The combination of dulaglutide and dapagliflozin improves arterial stiffness, endothelial glycocalyx and albuminuria compared to DPP-4is in patients with T2DM. Funding Acknowledgement: Type of funding sources: None.