Effects of Glucagon-Like Peptide-1 Receptor Agonists, Sodium-Glucose Cotransporter-2 Inhibitors, and Their Combination on Endothelial Glycocalyx, Arterial Function, and Myocardial Work Index in Patients With Type 2 Diabetes Mellitus After 12-Month Treatment

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Ignatios Ikonomidis 1, George Pavlidis 2, John Thymis 1, Dionysia Birba 1, Aimilianos Kalogeris 1, Foteini Kousathana 2, Aikaterini Kountouri 2, Konstantinos Balampanis 2, John Parissis 1, Ioanna Andreadou 3, Konstantinos Katogiannis 1, George Dimitriadis 2, Aristotelis Bamias 2, Efstathios Iliodromitis 1, Vaia Lambadiari

Main idea: Twelve-month treatment with GLP-1RA, SGLT-2i, and their combination showed a greater improvement of vascular markers and effective cardiac work than insulin treatment in type 2 diabetes mellitus. The combined therapy as second line was superior to either insulin or GLP-1RA and SGLT-2i separately.

Abstract

Background We investigated the effects of insulin, glucagon-like peptide-1 receptor agonists and inhibitors on vascular and cardiac function of patients with type 2 diabetes mellitus.

Methods and results: A total of 160 patients with type 2 diabetes mellitus were randomized to insulin, liraglutide, empagliflozin, or their combination (GLP-1RA+SGLT-2i) as add-on to metformin. We measured at baseline and 4 and 12 months post treatment. The dual therapy showed the greatest effect on measured markers in patients with left ventricular ejection fraction <55% (P<0.05) The dual Therapy showed the most effect on markers in those with left Ventricular ejections fraction < 55% and in patients who had less than 5% left ventricle ejection fractions (P <0.5). We found that the combination showed a greater reduction of perfused boundary region, PWV, and central systolic blood pressure than insulin, despite a similar glycosylated hemoglobin reduction.

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