Twelve-month treatment with liraglutide, empagliflozin, and their combination achieved greater reductions in cIMT (-8.2%, -5.6%, and -10.7%, respectively) than insulin (-1.7%; p<0.001).
Cohort (n=183)
Do liraglutide, empagliflozin, and their combination reduce carotid intima-media thickness in patients with type 2 diabetes mellitus compared to insulin?
In patients with type 2 diabetes, 12-month treatment with liraglutide, empagliflozin, or their combination significantly reduced carotid intima-media thickness compared to insulin, with the combination therapy showing the greatest reduction.
Absolute Event Rate: -10.7% vs -1.7%
p-value: p=<0.001
Abstract Background/Introduction Type 2 diabetes mellitus (T2DM) is an additional factor for exacerbation of atherosclerosis increasing the risk for coronary artery disease and ischemic stroke. Evaluation of carotid artery atherosclerosis through ultrasound techniques is an important method for risk stratification in patients with T2DM. Purpose We investigated the effect of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on carotid intima-media thickness (cIMT) of T2DM patients. Methods We studied 183 consecutive T2DM patients who were treated with insulin (n=45), liraglutide (GLP-1RA) (n=46), empagliflozin (SGLT-2i) (n=47) or their combination (liraglutide+empagliflozin) (n=45) as add-on to metformin and were matched using propensity score analysis. At baseline, at 6 and 12 months of treatment, we measured the maximal thickness of six major points including right and left common carotid, carotid bifurcation and internal carotids. Finally, we calculated the average cIMT of all six segments to get mean cIMT. In addition, lipid profile and malondialdehyde (MDA), as a marker of oxidative stress, were evaluated in all participants. Results Compared to baseline, all patients had significantly reduced cIMT, total cholesterol, low-density lipoprotein cholesterol, triglycerides and MDA at 6 and 12 months of treatment (p0.01). A significant interaction of follow-up time with the type of treatment was observed regarding cIMT levels (F=7.432, p for interaction 0.001). Age, sex, smoking, body mass index, glucose levels, glycosylated hemoglobin, levels of blood lipids and their changes at 6 and 12 months of treatment were included as covariates in our model to control for potential confounders. At 12 months, patients under liraglutide, empagliflozin and their combination achieved a greater reduction in cIMT (-8.2%, -5.6% and -10.7%) than those under insulin (-1.7%, p0.001 for all comparisons). The percentage reduction in cIMT was associated with the decrease in MDA (r=0.329, p=0.038). At baseline, 44 patients (10 patients in insulin group, 9 in liraglutide group, 13 in empagliflozin group, and 12 in liraglutide+empagliflozin group) had a baseline cIMT value 1.5mm, which is considered plaque equivalent. Of those, the percentage of patients who reduced cIMT 1.5mm after 12-month treatment was greater in the liraglutide, empagliflozin and combined therapy group (-67%, -54%, and -75%, respectively) compared to the insulin group (-40%; p0.05 for all comparisons) (Table). Conclusions Twelve-month treatment with GLP-1RA, SGLT-2i and their combination resulted in a significant reduction of cIMT in patients with T2DM. The combined therapy was superior and additive to each regimen separately.
Ikonomidis et al. (Sat,) conducted a cohort in Type 2 diabetes mellitus (n=183). Liraglutide, empagliflozin, and their combination vs. Insulin was evaluated on Percentage reduction in carotid intima-media thickness (cIMT) at 12 months (p=<0.001). Twelve-month treatment with liraglutide, empagliflozin, and their combination achieved greater reductions in cIMT (-8.2%, -5.6%, and -10.7%, respectively) than insulin (-1.7%; p<0.001).