Key result
Vildagliptin reduces glucose variability versus glibenclamide, but neither drug improves endothelial function.
Why the study?
Glucose variability contributes to cardiovascular disease and endothelial dysfunction in type 2 diabetes mellitus, but the comparative effects of DPP-4 inhibitors versus glibenclamide on glucose variability and endothelial function were not established.
Does vildagliptin reduce glucose variability and improve endothelial function compared to glibenclamide in patients with type 2 diabetes mellitus and hypertension?
RCT (n=50)
Open-label
randomized
Does vildagliptin reduce glucose variability and improve endothelial function compared to glibenclamide in patients with type 2 diabetes mellitus and hypertension?
Absolute Event Rate: 30.7% vs 37.5%
In patients with T2DM and hypertension, vildagliptin reduces glucose variability compared to glibenclamide, but neither treatment significantly improves endothelial function over 12 weeks.
Vildagliptin may be favored over glibenclamide for glucose variability control in T2DM with hypertension; extends evidence that GV reduction need not improve endothelial function.
Background: Glucose variability (GV) is considered an important factor for cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). High GV causes endothelial dysfunction and increased oxidative stress. Dipeptidyl peptidase-4 (DPP-4) inhibitors may improve endothelial function and decrease GV. The aim of this study was to investigate the effects of vildagliptin, a DPP-4 inhibitor, compared with glibenclamide in GV and endothelial function in patients with T2DM and arterial hypertension. Methods: This is a prospective, randomized, open and drug-controlled study. Fifty patients older than 35 years with T2DM and hypertension without CVD were randomized to receive vildagliptin (n=25) or glibenclamide (n=25), both in added-on metformin. Laboratory tests and analysis of endothelial function were performed before and 12 weeks after treatment. Endothelial function, defined by reactive hyperemia index (RHI), was analyzed by peripheral artery tonometry (endo-PAT2000). GV was evaluated by capillary glucose with intermittent monitoring device, six measurements per day, for three days, before and after treatment. The median of standard deviation (SD) of mean blood glucose (MBG) was used to evaluate GV. Results: GV decreased in the vildagliptin group (35.2 to 30.7, P =0.037) but did not change with glibenclamide (37.6 to 37.5, P =0.765). Glycated hemoglobin was similar in both groups. MBG decreased only in glibenclamide group, without difference with vildagliptin group ( P =0.374). There were no changes in the RHI in both groups and there was no correlation between GV and RHI ( P =0.658). Conclusion: Vildagliptin reduces GV; however, the action on endothelial function was not demonstrated. In addition, there was no correlation between GV and endothelial function.
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Cosenso‐Martin et al. (2020) conducted an RCT in Type 2 diabetes mellitus and hypertension (n=50). Vildagliptin vs. Glibenclamide was evaluated on Glucose variability (median of standard deviation of mean blood glucose). Vildagliptin reduced glucose variability (35.2 to 30.7, P=0.037) over 12 weeks, whereas glibenclamide did not, though neither treatment improved endothelial function.
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