Why the study?
The impact of DPP-4 inhibitors on vascular function, including endothelial function and arterial stiffness, in patients with type 2 diabetes mellitus remains unclear.
Does the combination of dulaglutide and dapagliflozin improve subclinical markers of vascular, renal, and cardiac function in patients with type 2 diabetes and albuminuria compared to DPP-4 inhibitors?
RCT (n=60)
Randomized
No
Does the combination of dulaglutide and dapagliflozin improve subclinical markers of vascular, renal, and cardiac function in patients with type 2 diabetes and albuminuria compared to DPP-4 inhibitors?
Absolute Event Rate: -52.3% vs -14.5%
p-value: p=<0.01
Early combination treatment with GLP-1RAs and SGLT-2is significantly improves markers of subclinical vascular disease and renal function in patients with type 2 diabetes, highlighting potential benefits for cardiorenal prevention.
Supports GLP-1RA/SGLT2i combination over DPP-4i for albuminuria in T2D; extends cardiorenal protection evidence from prior trials.
We systematically reviewed the literature regarding the impact of dipeptidyl peptidase-4 inhibitors (DPP-4i) on vascular function, including endothelial function and arterial stiffness, as predictors of atherosclerosis progression and cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). We searched PubMed in order to identify clinical trials that investigated the effect of DPP-4i on vascular function in patients with T2DM when compared with placebo. Although 168 articles were initially found, only 6 studies (total 324 patients) investigated the effect of DPP-4i in comparison with placebo, specifically linagliptin and sitagliptin, and satisfied the inclusion criteria. There are scarce data to indicate that linagliptin may enhance endothelial function and exert a slight beneficial effect on arterial wall properties. Sitagliptin seems to have a neutral effect on these variables. Further trials are needed to elucidate the topic. The standards of reporting were in accordance with the PRISMA guidelines.
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Paschou et al. (2020) conducted an RCT in Type 2 diabetes mellitus with albuminuria (n=60). Dulaglutide and dapagliflozin vs. DPP-4 inhibitor (sitagliptin, vildagliptin, alogliptin, or linagliptin) was evaluated on Change in urine albumin-to-creatinine ratio (UACR) at 12 months (p=<0.01).
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