Kidney Week

Abstract: SA-PO469

SGLT2 Inhibition Improves Vascular Function in Patients with Type 2 Diabetes: A Double-Blind, Randomized, Placebo-Controlled Crossover Trial

Session Information

• Diabetic Kidney Disease: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Kristensen, Didde Kidmose, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark

Didde Kidmose Kristensen,

• Nielsen, Steffen Flindt, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark

Steffen Flindt Nielsen,

• Buus, Niels Henrik, Aarhus Universitetshospital Afdeling Nyresygdomme, Aarhus, Denmark

Niels Henrik Buus,

• Mårup, Frederik Husum, Aarhus Universitetshospital Afdeling Nyresygdomme, Aarhus, Denmark

Frederik Husum Mårup,

• Bech, Jesper N., University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark

Jesper N. Bech,

• Duus, Camilla Lundgreen, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark

Camilla Lundgreen Duus,

• Mose, Frank H., University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark

Frank H. Mose,

Background

Sodium glucose co-transporter 2 inhibitors (SGLT2i) reduce cardiovascular events and protect kidney function in patients with type 2 diabetes (DM2). Improved vascular function may be a part of the explanation for this. Vasodilatory capacity in patients with DM2 after SGLT2 inhibition was examined in this study.

Methods

In a double-blind, randomized, placebo-controlled cross-over study, 15 patients with DM2 and preserved kidney function (eGFR > 60 ml/min/1.73 m²) were included. Participants received four weeks of SGLT2i treatment (empagliflozin 10 mg) and matching placebo in a random order separated by a two-week wash-out period. At the end of each treatment period vascular function was evaluated by venous occlusion plethysmography. Forearm blood flow (FBF) was measured during intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside (SNP) in increasing concentrations, assessing endothelium-dependent and independent vasodilation, respectively. Repeated measures two-way ANOVA was used to compare absolute FBF between groups.

Results

The majority of participants were male (73 %). Mean age was 68±9 (SD) years (range 49-82), eGFR was 81±10 ml/min/1.73 m² and duration of diabetes was 16±9 years. Hypertension was diagnosed in 11 (73 %) participants and 4 (27 %) had cardiovascular disease. Both ACh and SNP dose-dependently increased FBF (Figure 1 and 2). FBF was significantly higher during SNP infusion after empagliflozin treatment as compared to placebo (p=0.004). No difference in FBF was found between empagliflozin and placebo during ACh infusion (p=0.399).

Conclusion

Empagliflozin improves endothelium-independent vasodilatation in patients with DM2, whereas no changes could be observed in endothelium-dependent vasodilation. These results suggest that SGLT2 inhibition positively affects vascular function, however the improvement does not appear to be related to improvement of the endothelial function.

Funding

• Commercial Support – Boeringer-Ingelheim provided cost-free project medicine and matching placebo