Dissertation committee:
Ράπτης Αθανάσιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Οικονομίδης Ιγνάτιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Λαμπαδιάρη Βάια, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μακρυλάκης Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τεντολούρης Νικόλαος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Λιονάκη Σοφία, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Οικονόμου Ευάγγελος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
BACKGROUND: The association between diabetes mellitus and
diabetic nephropathy with vascular and endothelial properties is wellestablished.
In this study, we compared the effect of combined treatment with
dulaglutide and dapagliflozin versus DPP-4 inhibitors on endothelial glycocalyx,
arterial stiffness, myocardial function and albuminuria in patients with type 2
diabetes mellitus and albuminuria.
METHODS: A total of 60 patients with type 2 diabetes mellitus and
albuminuria were randomized to combined dulaglutide and dapagliflozin
treatment (n=30) or DPP-4 inhibitors (DPP-4is, n=30). We measured at
baseline and 4 and 12 months posttreatment: (a) perfused boundary region of
the sublingual arterial microvessels (marker of endothelial glycocalyx
thickness), (b) pulse wave velocity (PWV) and central systolic blood pressure
(cSBP), (c) global left ventricular longitudinal strain (GLS) (d) urine albumin-tocreatinine
ratio (UACR).
RESULTS: Twelve months posttreatment, the combination of
dulaglutide and dapagliflozin showed a greater improvement in all indices
compared to DPP-4is, despite a similar reduction in glycosylated hemoglobin.
Specifically, dual therapy showed greater improvements vs DPP-4is in PBR
(2,10±0,31 to 1,93±0,23 μm vs 2,11±0,31 to 2,08±0,28 μm, p<0,001), in UACR
(326±61 to 142±47 mg/g vs 345±48 to 306±60 mg/g, p<0,01), and in PWV
(11,77±2,37 to 10,7±2,29 m/s vs 10,64±2,44 to 10,54±2,84 m/s, p<0,001), while
only dual therapy showed improvement in cSBP (130,21±17,23 to
123,36±18,42 mmHg). Regarding GLS, both treatments were effective, but dual
therapy showed a significantly higher percentage improvement compared to
DPP-4is (18,19% vs 6,01%, respectively).
CONCLUSIONS: Twelve-month treatment with dulaglutide and
dapagliflozin showed a greater improvement in vascular markers an
albuminuria than DPP-4is in patients with type 2 diabetes mellitus and
albuminuria. Early initiation of combined therapy as add-on to metformin should
be considered in these patients.
Keywords:
Type 2 diabetes mellitus, Albuminuria, Arterial stiffness, Glycocalyx, Novel antidiabetic medication
