In type 2 diabetes, liraglutide, empagliflozin, and their combination reduced carotid intima-media thickness by 8.2%, 5.6%, and 10.7%, respectively, compared to insulin's 1.7%.
Do GLP-1 receptor agonists, SGLT-2 inhibitors, or their combination improve carotid atherosclerosis and oxidative stress markers compared to insulin in metformin-treated T2DM patients?
In T2DM patients, GLP-1RA and SGLT-2i, especially in combination, significantly improve carotid atherosclerotic burden and oxidative stress markers compared to insulin.
Absolute Event Rate: 0% vs 0%
Carotid intima–media thickness (cIMT), amyloid-β1–40 (Aβ1–40) and oxidative stress are markers of vascular ageing and cardiovascular risk. We compared the effects of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium–glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on the above markers in type-2 diabetes (T2DM). We prospectively studied 183 metformin-treated T2DM patients, propensity-score–matched to 12-month treatment with insulin, liraglutide, empagliflozin or liraglutide plus empagliflozin. Six-segment cIMT and plaque-equivalent lesions (cIMT≥1.5mm) were assessed at baseline, 6 and 12 months; plasma Aβ1–40 and malondialdehyde (MDA) were measured. All regimens were associated with reductions in cIMT and Aβ1–40 at 12 months (P<0.05). MDA decreased overall with the largest reduction in GLP-1RA–based regimens. Compared with insulin, liraglutide, empagliflozin and combination achieved greater reductions in cIMT (-8.2%, -5.6% and -10.7% vs -1.7%, P<0.05) and in Aβ1–40 (-52.1%, -40.3% and -50.7% vs -30.7%, P<0.05). Patients achieving cIMT <1.5mm at 12 months was highest with combination therapy (75%), followed by liraglutide (67%) and empagliflozin (54%) versus insulin (40%; P<0.05). Patients who regressed <1.5mm showed greater reduction in Aβ1–40 than those with ≥1.5mm (-56.2% vs -25.1%, P=0.028). Liraglutide, empagliflozin and combination induced greater reduction of cIMT (-8.2%, -5.6% and -10.7% vs -1.7%) and Aβ1–40 (-52.1%, -40.3% and -50.7% vs -30.7%; P<0.05) compared to insulin. cIMT regression was associated with Aβ1–40 and MDA reductions (P<0.05). In T2DM patients, GLP-1RA and SGLT-2i—particularly in combination—were associated with improvements in carotid atherosclerotic burden, amyloid-related vascular injury and oxidative stress.
Ikonomidis et al. (Sat,) reported a other. In type 2 diabetes, liraglutide, empagliflozin, and their combination reduced carotid intima-media thickness by 8.2%, 5.6%, and 10.7%, respectively, compared to insulin's 1.7%.