Diabetes, Metabolic Syndrome and Obesity (Sep 2020)
Randomized Study Comparing Vildagliptin vs Glibenclamide on Glucose Variability and Endothelial Function in Patients with Type 2 Diabetes Mellitus and Hypertension
Abstract
Luciana Neves Cosenso-Martin, Lais Yumi Takaoka, Jose Fernando Vilela-Martin Internal Medicine Division, State Medical School at Sao Jose do Rio Preto (FAMERP), Hospital de Base, Sao Jose do Rio Preto, Sao Paulo, BrazilCorrespondence: Jose Fernando Vilela-MartinState Medical School at Sao Jose do Rio Preto (FAMERP), Hospital de Base, Ave Brig. Faria Lima 5416, Sao Jose do Rio Preto, Sao Paulo 15090-000, BrazilTel +55 17 32015727Email [email protected]: 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.Keywords: type 2 diabetes, hypertension, glycemic variability, vascular endothelium, dipeptidyl-peptidase IV inhibitors, arterial stiffness
