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Abstract: SA-PO469

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

Session Information

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
  • Nielsen, Steffen Flindt, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
  • Buus, Niels Henrik, Aarhus Universitetshospital Afdeling Nyresygdomme, Aarhus, Denmark
  • Mårup, Frederik Husum, Aarhus Universitetshospital Afdeling Nyresygdomme, Aarhus, Denmark
  • Bech, Jesper N., University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
  • Duus, Camilla Lundgreen, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
  • Mose, Frank H., University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
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