We investigated the effects of SGLT2 inhibitors on blood pressure, baPWV,carotid arterial IMT and elastic modulus in type 2 diabetic patients with obesity.Design and method:
The thirty-one patients with diabetes mellitus and obesity (average age: 53 years old, BMI31 kg/m2) were treated with SGLT2 inhibitors (one of the following drugs: Ipragliflozin, Dapagliflozin, Luseogliflozin, Tofogliflozin, Canagliflozin, Empagliflozin) for 12 months. Serum markers, office and central blood pressures and brachial-ankle pulse wave velocity (baPWV) were examined. The intima-media thickness (IMT) and elastic modulus in the circumferential direction (E θ) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”.Results:
The basal values of fasting blood sugar (FPG), HbA1c, body weight, TG, HDL-C, LDL-C, AST, ALT, γ-GTP, uric acid (UA), eGFR, office blood pressure (BP), pulse pressure, baPWV, central SBP (cSBP), IMT, E θ were the followings: 126 ± 30 mg/dL, 7.6 ± 1.5%, 87.9 ± 18.5 kg, 153 ± 39 mg/dL, 46 ± 10 mg/dL, 105 ± 31 mg/dL, 41 ± 34IU, 45 ± 28IU, 49 ± 40IU, 6.0 ± 1.0 mg/dL, 79.0 ± 20.8 ml/min./1.73m2, 131 ± 15/79 ± 9mmHg, 52 ± 10mmHg, 1618 ± 285 cm/sec, 136 ± 14mmHg, 1.34 ± 0.48 mm, 318 ± 89kPa. After 12 months of administration of SGLT2 inhibitors, FPG (-12%), HbA1c (-8%) and body weight (-2%) decreased significantly (p < 0.05). As for liver function, AST (-33%), ALT (-29%) and γ-GTP (-18%) also decreased significantly. No significant changes were seen in TG, HDL-C and eGFR. The drugs also decreased LDL-C (-10%), UA (-19%), office BP (-6%/-6%, cSBP (-8%), baPWV (-8%), IMT (-9%) and E θ (-23%) significantly. The histogram analysis of the E θ data revealed both of the drugs decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction.Conclusions:
Our results indicate that SGLT2 inhibitors may have effects on blood pressure, IMT and E θ and baPWV to improve the distortion in the intramural elasticity distribution in arteries in type 2 diabetic patients with obesity. The measurement of the carotid elastic modulus may be useful to evaluate the efficacy of drugs for improving regional atherosclerotic changes.