Early action if new oral hypoglicaemic agents on echocardiographic parameters

Abstract Background Early cardiac dysfunction is frequently observed in individuals with type 2 diabetes (T2D). Although sodium–glucose cotransporter-2 inhibitors (SGLT2-i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and dual GIP/GLP-1RA have demonstrated cardiovascular benefits, their early cardiac effects in newly diagnosed T2D patients remain insufficiently explored. In particular, data on tissue Doppler imaging (TDI), right ventricular (RV) function, and pulmonary pressures are limited. Purpose To determine whether early initiation of GIP/GLP-1RA therapy leads to more pronounced short-term improvements in cardiac structure and function compared with SGLT2-i therapy in newly diagnosed T2D patients. Methods Between April and October 2025, 34 adults with newly diagnosed T2D (13 women, 21 men) were enrolled at an Internal Medicine Unit in Italy. According to standard clinical practice, 19 patients initiated GIP/GLP-1RA and 15 initiated SGLT2-i. All subjects underwent clinical and comprehensive echocardiographic evaluation at baseline and 3 months. Assessed parameters included left ventricular (LV) ejection fraction (Simpson method), E/A and E/e′ ratios, indexed LV end-diastolic diameter, proximal RV outflow tract (RVOTp) diameter, left atrial volume index (LAVI), right atrial area, RV systolic function by TAPSE and TDI-derived s′ velocity, and systolic pulmonary artery pressure (sPAP). Non-parametric tests were used for within- and between-group comparisons. Results Baseline demographic and clinical features were comparable between groups, except for higher BMI and HbA1c and younger age in the GIP/GLP-1RA group (Table 1). After 3 months, both treatments produced significant cardiometabolic and echocardiographic improvements (Table 2). In the GIP/GLP-1RA group, significant improvements were observed in LAVI (p=0.019), diastolic function (E/e′ p=0.004), LV systolic performance (s′ p=0.001), RVOTp (p=0.007), sPAP (p0.0001), and TAPSE/sPAP ratio (p0.0001). TAPSE increased significantly only in this group (p=0.012). In the SGLT2-i group, improvements were observed in LV diastolic diameter indexed to BSA (p=0.004), E/e′ (p=0.013), s′ (p=0.017), RVOTp (p=0.016), sPAP (p=0.001), and TAPSE/sPAP ratio (p=0.001). No significant differences were detected between groups in the magnitude of echocardiographic changes (all p0.18), despite a numerically broader pattern of improvements with GIP/GLP-1RA. Conclusions Both GIP/GLP-1RA and SGLT2-i therapies promote rapid improvement in cardiac structure and function in newly diagnosed T2D subjects. GIP/GLP-1RA therapy is associated with early and consistent benefits across multiple domains suggesting an early reverse-remodelling effect and improved cardiopulmonary interaction. These findings support early initiation of incretin-based therapy as part of cardiometabolic prevention strategies in T2D.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.