Key result
Incretin-based drugs fail to improve diastolic dysfunction compared to standard metformin therapy.
Why the study?
Left ventricular diastolic dysfunction is a subclinical cardiac abnormality in patients with T2DM that can progress to heart failure and increase cardiovascular risk.
Does incretin-based treatment improve diastolic dysfunction in patients with uncontrolled type 2 diabetes mellitus without atherosclerotic cardiovascular disease?
Cohort (n=138)
No
Does incretin-based treatment improve diastolic dysfunction in patients with uncontrolled type 2 diabetes mellitus without atherosclerotic cardiovascular disease?
Adding incretin-based therapies to standard care in uncontrolled T2DM offers metabolic and anti-inflammatory benefits but may not significantly reverse early diastolic dysfunction over a 1-year period.
Incretin-based therapy should not yet target diastolic dysfunction in T2DM; leaves open randomized trials of longer duration or specific agents.
Left ventricular diastolic dysfunction (DD) is a subclinical cardiac abnormality in patients with type 2 diabetes mellitus (T2DM) that can progress to heart failure (HF) and increase cardiovascular risk. This prospective study evaluated the DD in T2DM patients without atherosclerotic cardiovascular disease after one year of incretin-based drugs added to standard treatment. Of the 138 enrolled patients (49.30% male, mean age 57.86 ± 8.82, mean T2DM history 5 years), 71 were started on dipeptidyl peptidase-4 inhibitor sitagliptin/saxagliptin, 21 on glucagon-like peptide-1 receptor agonist exenatide, and 46 formed the control group (metformin and sulphonylurea/acarbose). At baseline, 71 patients had grade 1 DD, another 12 had grade 2 and 3 DD, and 15 had indeterminate DD. After one year, DD was evidenced in 50 cases. Diastolic function improved in 9 cases, and 27 patients went from grade 1 to indeterminate DD. The active group benefited more, especially patients treated with exenatide; their metabolic and inflammation profiles also improved the most. An in-depth analysis of echocardiographic parameters and paraclinical results in the context of literature data justifies the conclusion that early assessment of diastolic function in T2DM patients is necessary and the benefits of affordable incretin-based treatment may extend to subclinical cardiovascular manifestations such as DD.
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Grigorescu et al. (2023) conducted a cohort in Uncontrolled Type 2 Diabetes Mellitus without atherosclerotic cardiovascular disease (n=138). Incretin-based drugs (exenatide or sitagliptin/saxagliptin) vs. Standard treatment (metformin and sulphonylurea/acarbose) was evaluated on Changes in diastolic dysfunction at 1 year. Incretin-based drugs added to standard therapy for 1 year improved metabolic and inflammatory profiles but did not significantly improve diastolic dysfunction compared to standard metformin treatment.
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