TY - JOUR
T1 - Comparison of effects of sitagliptin and voglibose on left ventricular diastolic dysfunction in patients with type 2 diabetes
T2 - Results of the 3D trial
AU - FESC, for Effect of a DPP-4 inhibitor on left ventricular diastolic dysfunction in patients with type 2 diabetes and diabetic cardiomyopathy (3D) study investigators
AU - Oe, Hiroki
AU - Nakamura, Kazufumi
AU - Kihara, Hajime
AU - Shimada, Kenei
AU - Fukuda, Shota
AU - Takagi, Tsutomu
AU - Miyoshi, Toru
AU - Hirata, Kumiko
AU - Yoshikawa, Junichi
AU - Ito, Hiroshi
N1 - Funding Information:
This study was supported by the Osaka Foundation for the Prevention of Cancer and Cardiovascular Diseases. The authors would like to thank Tetsutaro Hamano for assistance with statistical analysis. We also thank the 3D study investigators: Kazufumi Nakamura, MD; Toru Miyoshi, MD, Hiroshi Ito, MD (Okayama University, Okayama, Japan), Hajime Kihara, MD (Kihara Cardiovascular Clinic), Kenei Shimada, MD (Osaka City University of Medicine), Shota Fukuda, MD (Osaka Ekisaikai Hospital), Tsutomu Takagi, MD (Takagi Cardiology Clinic), Kumiko Hirata, MD (Wakayama Medical University) and Junichi Yoshikawa, MD (Nishinomiya Watanabe Cardiovascular Center).
Publisher Copyright:
© 2015 Oe et al.
PY - 2015/6/19
Y1 - 2015/6/19
N2 - Background: Left ventricular (LV) diastolic dysfunction is frequently observed in patients with type 2 diabetes. Dipeptidyl peptidase-4 inhibitor (DPP-4i) attenuates postprandial hyperglycemia (PPH) and may have cardio-protective effects. It remains unclear whether DPP-4i improves LV diastolic function in patients with type 2 diabetes, and, if so, it is attributable to the attenuation of PPH or to a direct cardiac effect of DPP-4i. We compared the effects of the DPP-4i, sitagliptin, and the alpha-glucosidase inhibitor, voglibose, on LV diastolic function in patients with type 2 diabetes. Methods: We conducted a prospective, randomized, open-label, multicenter study of 100 diabetic patients with LV diastolic dysfunction. Patients received sitagliptin (50mg/day) or voglibose (0.6mg/day). The primary endpoints were changes in the e' velocity and E/e' ratio from baseline to 24weeks later. The secondary efficacy measures included HbA1c, GLP-1, lipid profiles, oxidative stress markers and inflammatory markers. Results: The study was completed with 40 patients in the sitagliptin group and 40 patients in the voglibose group. There were no significant changes in the e' velocity and E/e' ratio from baseline to 24weeks later in both groups. However, analysis of covariance demonstrated that pioglitazone use is an independent factor associated with changes in the e' and E/e' ratio. Among patients not using pioglitazone, e' increased and the E/e' ratio decreased in both the sitagliptin and voglibose groups. GLP-1 level increased from baseline to 24weeks later only in the sitagliptin group (4.8 ± 4.7 vs. 7.3 ± 5.5 pmol/L, p < 0.05). The reductions in HbA1c and body weight were significantly greater in the sitagliptin group than in the voglibose group (-0.7 ± 0.6% vs. -0.3 ± 0.4, p < 0.005; -1.3 ± 3.2kg vs. 0.4 ± 2.8kg, p < 0.05, respectively). There were no changes in lipid profiles and inflammatory markers in both groups. Conclusions: Our trial showed that sitagliptin reduces HbA1c levels more greatly than voglibose does, but that neither was associated with improvement in the echocardiographic parameters of LV diastolic function in patients with diabetes. Trial registration: Registered at http://www.umin.ac.jp under UMIN000003784.
AB - Background: Left ventricular (LV) diastolic dysfunction is frequently observed in patients with type 2 diabetes. Dipeptidyl peptidase-4 inhibitor (DPP-4i) attenuates postprandial hyperglycemia (PPH) and may have cardio-protective effects. It remains unclear whether DPP-4i improves LV diastolic function in patients with type 2 diabetes, and, if so, it is attributable to the attenuation of PPH or to a direct cardiac effect of DPP-4i. We compared the effects of the DPP-4i, sitagliptin, and the alpha-glucosidase inhibitor, voglibose, on LV diastolic function in patients with type 2 diabetes. Methods: We conducted a prospective, randomized, open-label, multicenter study of 100 diabetic patients with LV diastolic dysfunction. Patients received sitagliptin (50mg/day) or voglibose (0.6mg/day). The primary endpoints were changes in the e' velocity and E/e' ratio from baseline to 24weeks later. The secondary efficacy measures included HbA1c, GLP-1, lipid profiles, oxidative stress markers and inflammatory markers. Results: The study was completed with 40 patients in the sitagliptin group and 40 patients in the voglibose group. There were no significant changes in the e' velocity and E/e' ratio from baseline to 24weeks later in both groups. However, analysis of covariance demonstrated that pioglitazone use is an independent factor associated with changes in the e' and E/e' ratio. Among patients not using pioglitazone, e' increased and the E/e' ratio decreased in both the sitagliptin and voglibose groups. GLP-1 level increased from baseline to 24weeks later only in the sitagliptin group (4.8 ± 4.7 vs. 7.3 ± 5.5 pmol/L, p < 0.05). The reductions in HbA1c and body weight were significantly greater in the sitagliptin group than in the voglibose group (-0.7 ± 0.6% vs. -0.3 ± 0.4, p < 0.005; -1.3 ± 3.2kg vs. 0.4 ± 2.8kg, p < 0.05, respectively). There were no changes in lipid profiles and inflammatory markers in both groups. Conclusions: Our trial showed that sitagliptin reduces HbA1c levels more greatly than voglibose does, but that neither was associated with improvement in the echocardiographic parameters of LV diastolic function in patients with diabetes. Trial registration: Registered at http://www.umin.ac.jp under UMIN000003784.
KW - Alpha-glucosidase inhibitor
KW - Dipeptidyl peptidase 4 (DPP-4) inhibitors
KW - LV diastolic function
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UR - http://www.scopus.com/inward/citedby.url?scp=84934910233&partnerID=8YFLogxK
U2 - 10.1186/s12933-015-0242-z
DO - 10.1186/s12933-015-0242-z
M3 - Article
C2 - 26084668
AN - SCOPUS:84934910233
SN - 1475-2840
VL - 14
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 83
ER -
